- Email: [email protected]
Spontaneous Coronary Artery Dissection in Young Women Presenting with Acute Coronary Syndrome
S3
CWHHS Abstracts
and HRQOL scores in a cohort of patients undergoing cardiac catheterization for CAD. METHODS: Questions that comprised the GGI were included in the follow-up questionnaire sent to patients in the APPROACH registry. To examine the relationship between sex, gender and health status, we used a sequential linear regression modeling approach. Five linear regression models were built for each of the five SAQ domains with sequential adjustment for sex alone, age and finally the GGI index. Estimated means for each of the SAQ scale scores were calculated to determine the mean difference in SAQ dimensional scores between sexes after adjusting for age and GGI. As logistic regression models were run using the dichotomized SAQ dimensional scores as the dependent variables. RESULTS: A total of 632 patients who underwent an index angiogram in Alberta, Canada completed the APPROACH follow-up survey between July 1 2015 and August 31 2015. Of the 532 (84%) who completed all the questions in the GGI, 24.4 % were women (n¼130). The women were significantly older (68 years vs 66 years, p¼ 0.02), and significantly more likely to have hypertension (50.8% vs 38.8, p¼0.02) compared to the men. Women reported significantly lower mean SAQ scale scores compared to men. The inclusion of age into the models did not change the relationship between sex and the SAQ scales. However the inclusion of the GGI attenuated the relationship between sex and the SAQ scales scores. Men were more likely to report perfect SAQ dimensional scores (100) in all 5 scales compared to women and these relationships were significant in the Physical Limitation and Treatment Satisfaction scales. The inclusion of the GGI in the models attenuated the ‘sex’ differences in the SAQ mean scores. Furthermore c statistics indicated that including the GGI increased the discrimination of the models in all SAQ dimensional scales. CONCLUSIONS: Our results support the concept that sex differences in health status outcomes may be better explained by patient gender related characteristics, than biological sex characteristics. More importantly the GGI offers a pragmatic composite score to assess the effects of psychosocial factors that researchers interested in measuring gender could use in studies of subjects with CAD. 5 SPONTANEOUS CORONARY ARTERY DISSECTION IN YOUNG WOMEN PRESENTING WITH ACUTE CORONARY SYNDROME
A Shimony, L Pilote, H Al Lawati, A Bagai, H Behlouli, M Eisenberg, D So, I Karp, AN Cheema for the GENESIS PRAXY Team Toronto, Ontario BACKGROUND:
The pathophysiology of acute coronary syndrome (ACS) in women is complex and may involve nonatherosclerotic mechanisms. Spontaneous coronary artery dissection (SCAD) is a rare cause of ACS that predominantly affects younger women. However, limited information is available for its incidence, clinical course and outcomes compared to younger women with acute coronary syndrome (ACS) not associated with SCAD. METHODS: Gender and Sex determinants of cardiovascular disease: From bench to beyond-Premature Acute Coronary Syndrome (GENESIS-PRAXY) study is multicenter prospective study of ACS patients aged 18 to 55 years. Detailed demographic, clinical, laboratory and outcome data were collected and coronary angiograms analyzed in a blinded manner. RESULTS: Among 383 women with ACS, 42 (11%) had SCAD confirmed by angiography. Multiple SCAD were present in 9 (21%) patients. Compared with no-SCAD patients, SCAD subjects were more likely to have absence of any cardiac risk factor (24% vs 7%, p¼0.0001), lower LDL (2.50.9 vs 3.01.2 mmol/L, p¼0.06) and higher HDL (2.34.7 vs 1.10.5 mmol/L p¼0.0002) levels. Single vessel disease was more common (81% vs. 50%, p¼0.0002) and SYNTAX score lower (86 vs. 128, p¼0.002) in SCAD compared to no-SCAD patients. Coronary intervention was less commonly performed (43% vs 73%, p<0.0001) and TIMI 3 flow less commonly achieved (77% vs 93%, p¼0.003) in SCAD compared with no-SCAD patients. The presence of autoimmune disease, connective tissue disorders were similar between the SCAD and no-SCAD group. Coronary hypertortuosity was identified in 95% of SCAD compared with 7% of no-SCAD patients, (p<0.0001). At 12 months follow up, SCAD patients were more likely to experience repeat hospitalization compared to no-SCAD patients (29% vs 16, p¼0.04) with similar no difference in overall major adverse cardiac events (MACE). CONCLUSION: SCAD is an important and not infrequent cause of ACS in younger women. Despite a low risk factor and angiographic burden of atherosclerosis, a significant proportion of SCAD patients experience repeat hospitalization and MACE at one year. These findings underscore the need for greater understanding of SCAD mechanisms and better risk stratification for improving outcome in this high risk group.
CWHHS Abstracts
and HRQOL scores in a cohort of patients undergoing cardiac catheterization for CAD. METHODS: Questions that comprised the GGI were included in the follow-up questionnaire sent to patients in the APPROACH registry. To examine the relationship between sex, gender and health status, we used a sequential linear regression modeling approach. Five linear regression models were built for each of the five SAQ domains with sequential adjustment for sex alone, age and finally the GGI index. Estimated means for each of the SAQ scale scores were calculated to determine the mean difference in SAQ dimensional scores between sexes after adjusting for age and GGI. As logistic regression models were run using the dichotomized SAQ dimensional scores as the dependent variables. RESULTS: A total of 632 patients who underwent an index angiogram in Alberta, Canada completed the APPROACH follow-up survey between July 1 2015 and August 31 2015. Of the 532 (84%) who completed all the questions in the GGI, 24.4 % were women (n¼130). The women were significantly older (68 years vs 66 years, p¼ 0.02), and significantly more likely to have hypertension (50.8% vs 38.8, p¼0.02) compared to the men. Women reported significantly lower mean SAQ scale scores compared to men. The inclusion of age into the models did not change the relationship between sex and the SAQ scales. However the inclusion of the GGI attenuated the relationship between sex and the SAQ scales scores. Men were more likely to report perfect SAQ dimensional scores (100) in all 5 scales compared to women and these relationships were significant in the Physical Limitation and Treatment Satisfaction scales. The inclusion of the GGI in the models attenuated the ‘sex’ differences in the SAQ mean scores. Furthermore c statistics indicated that including the GGI increased the discrimination of the models in all SAQ dimensional scales. CONCLUSIONS: Our results support the concept that sex differences in health status outcomes may be better explained by patient gender related characteristics, than biological sex characteristics. More importantly the GGI offers a pragmatic composite score to assess the effects of psychosocial factors that researchers interested in measuring gender could use in studies of subjects with CAD. 5 SPONTANEOUS CORONARY ARTERY DISSECTION IN YOUNG WOMEN PRESENTING WITH ACUTE CORONARY SYNDROME
A Shimony, L Pilote, H Al Lawati, A Bagai, H Behlouli, M Eisenberg, D So, I Karp, AN Cheema for the GENESIS PRAXY Team Toronto, Ontario BACKGROUND:
The pathophysiology of acute coronary syndrome (ACS) in women is complex and may involve nonatherosclerotic mechanisms. Spontaneous coronary artery dissection (SCAD) is a rare cause of ACS that predominantly affects younger women. However, limited information is available for its incidence, clinical course and outcomes compared to younger women with acute coronary syndrome (ACS) not associated with SCAD. METHODS: Gender and Sex determinants of cardiovascular disease: From bench to beyond-Premature Acute Coronary Syndrome (GENESIS-PRAXY) study is multicenter prospective study of ACS patients aged 18 to 55 years. Detailed demographic, clinical, laboratory and outcome data were collected and coronary angiograms analyzed in a blinded manner. RESULTS: Among 383 women with ACS, 42 (11%) had SCAD confirmed by angiography. Multiple SCAD were present in 9 (21%) patients. Compared with no-SCAD patients, SCAD subjects were more likely to have absence of any cardiac risk factor (24% vs 7%, p¼0.0001), lower LDL (2.50.9 vs 3.01.2 mmol/L, p¼0.06) and higher HDL (2.34.7 vs 1.10.5 mmol/L p¼0.0002) levels. Single vessel disease was more common (81% vs. 50%, p¼0.0002) and SYNTAX score lower (86 vs. 128, p¼0.002) in SCAD compared to no-SCAD patients. Coronary intervention was less commonly performed (43% vs 73%, p<0.0001) and TIMI 3 flow less commonly achieved (77% vs 93%, p¼0.003) in SCAD compared with no-SCAD patients. The presence of autoimmune disease, connective tissue disorders were similar between the SCAD and no-SCAD group. Coronary hypertortuosity was identified in 95% of SCAD compared with 7% of no-SCAD patients, (p<0.0001). At 12 months follow up, SCAD patients were more likely to experience repeat hospitalization compared to no-SCAD patients (29% vs 16, p¼0.04) with similar no difference in overall major adverse cardiac events (MACE). CONCLUSION: SCAD is an important and not infrequent cause of ACS in younger women. Despite a low risk factor and angiographic burden of atherosclerosis, a significant proportion of SCAD patients experience repeat hospitalization and MACE at one year. These findings underscore the need for greater understanding of SCAD mechanisms and better risk stratification for improving outcome in this high risk group.