Spain: Study on Primary Percutaneous Coronary Intervention in SCAD Patients

Primary percutaneous coronary intervention (PPCI), when indicated in patients with STEMI secondary to spontaneous coronary artery dissection (SCAD), can produce similar in-hospital mortality and 30-day readmission rates compared with PPCI for atherothrombotic STEMI, recent data suggests.

The findings of the study, published in JACC: Cardiovascular Interventions, support the value of PPCI in selected patients with SCAD.

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction (AMI). Revascularization in SCAD is very challenging and is therefore not recommended as the initial management strategy in stable SCAD in the absence of high-risk features. Therefore, Fernando Alfonso and colleagues from Spain aimed to compare in-hospital mortality and 30-day readmission rates between SCAD patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention and patients with STEMI without SCAD undergoing PPCI.

For this purpose, the researchers used the administrative minimum dataset of the Spanish National Health System (2016-2020). The calculation of risk-standardized in-hospital mortality ratios and readmission ratios was done. Adjustments of the results were done using propensity score (PS) analyses.

After exclusions, the team identified a total of 65,957 episodes of primary percutaneous coronary intervention.

Findings

• The crude in-hospital mortality rate was 4.8%. Of these, 315 (0.5%) were SCAD PPCI and 65,642 were non-SCAD PPCI.
• SCAD PPCI patients were younger and more frequently women than non-SCAD PPCI patients.
• Crude mortality (5.7% vs 4.8%), risk-standardized in-hospital mortality ratio (5.3% vs 5.3%), and PS-adjusted (315 pairs) mortality (5.7% vs 5.7%) were similar in SCAD PPCI and non-SCAD PPCI patients.
• Crude (3% vs 3.3%) and PS-adjusted (297 pairs) 30-day readmission rates (3% vs 4%) were also similar in both groups.

A separate analysis comprising only SCAD patients revealed that compared with those whose STEMI was managed conservatively, those who underwent primary PCI appeared to have high-risk characteristics -- they were more likely to be men, to be older, and to have anterior STEMI, heart failure, diabetes, or cardiogenic shock.

“Our findings suggest that when indicated, primary PCI should not be withheld from SCAD patients presenting with STEMI,” the authors conclude.

Reference

Alfonso F, Fernández-Pérez C, Del Prado N, García-Guimaraes M, Bernal JL, Bastante T, Del Val D, Rosillo N, Elola J. Primary Percutaneous Coronary Intervention in Patients With Spontaneous Coronary Artery Dissection vs Coronary Artery Disease. JACC Cardiovasc Interv. 2023 Aug 14;16(15):1860-1869. doi: 10.1016/j.jcin.2023.05.044. PMID: 37587593.