4. Introduction
SCAD is spontaneous dissection of the coronary artery wall that is not iatrogenic
or related to trauma
Important cause of MI especially in young females, real incidence is unknown.
Diagnosis is increasing -> Intravascular imaging
Platelet inhibition -> worsen intramural haemorrhage VS. reduce the thrombotic
risk linked to sub-endothelium exposure to flowing blood and reduce
shear-mediated platelet activation
SCAD usually managed conservatively
AIM: evaluate the safety of DAPT vs. single APT (SAPT) in medically managed
patients with SCAD.
5. Methods
Observational, multicentre, retrospective registry, from 1 January 2009 to 31 December
2019.
Patients from 23 centres in Italy and Spain non-atherosclerotic SCAD and aged >18 years
Inclusion criteria:
-conservative medical treatment as the initial strategy
- availability of data on Antiplatlet therapy
Patients -> two groups after diagnosis:
-SAPT (with either aspirin 100 mg or a P2Y12 inhibitor)
-DAPT (with aspirin 100 mg plus a P2Y12 inhibitor).
Presence of significant atherosclerotic disease (>_50% diameter stenosis) or complicated
plaque were excluded.
6. Definitions and outcomes
Type 1 angiographic radiolucent ‘flap’ and linear double lumen often associated
with contrast hold-up
Type 2 long (>20 mm) diffuse and smooth stenosis
type 2a; Distal vessel of a normal caliber
type 2b; stenosis extends to the end of the vessel
Type 3 focal stenosis indistinguishable from a focal atherosclerotic stenosis
requiring confirmation by intracoronary imaging.
Type 4 Complete occlusion pattern ( with type 1 or 2 present during baseline
injection or during intervention )
7. Definition and outcomes
Primary outcome : 12 months MACE
Secondary:
(i) in-hospital MACE;
(ii) single MACE components both in hospital and at 12 months;
(iii) bleeding events
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14. Limitations
Observational study , No randomization of patients
No clear basis on DAPT vs SAPT choice
Some patients with atherosclerotic coronary artery disease may
have been included (limited imaging)
The influence of imaging tools on antiplatelets cannot be excluded.
15. Conclusions
Risk of subsequent MI or need for revascularization occurs mostly in the 1st month.
DAPT is currently the most frequently adopted regimen in conservative mgt.
DAPT entailed a more than two-fold increased risk of MACE compared with SAPT
after 12 months of follow-up.(is it really DAPT ?)
This supports the use of APT therapy but does not favour SAPT over DAPT.
16. Unaddressed Issues
The prevalence of Fibromuscular dysplasia
Impact of pregnancy
The interventional group ?
Shortened DAPT ?
Anticoagulation
