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Coronary Artery Tortuosity in Spontaneous Coronary Artery Dissection: Angiographic Characteristics and Clinical Implications

Circulation. Cardiovascular interventions, 2014-10, Vol.7 (5), p.656-662 [Peer Reviewed Journal]

2014 American Heart Association, Inc. ;ISSN: 1941-7640 ;EISSN: 1941-7632 ;DOI: 10.1161/CIRCINTERVENTIONS.114.001676 ;PMID: 25138034

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Title:
Coronary Artery Tortuosity in Spontaneous Coronary Artery Dissection: Angiographic Characteristics and Clinical Implications
Author: Eleid, Mackram F ; Guddeti, Raviteja R ; Tweet, Marysia S ; Lerman, Amir ; Singh, Mandeep ; Best, Patricia J ; Vrtiska, Terri J ; Prasad, Megha ; Rihal, Charanjit S ; Hayes, Sharonne N ; Gulati, Rajiv
Subjects: Acute Coronary Syndrome - diagnostic imaging ; Acute Coronary Syndrome - etiology ; Acute Coronary Syndrome - pathology ; Adult ; Biomarkers - metabolism ; Case-Control Studies ; Causality ; Coronary Angiography ; Coronary Vessel Anomalies - complications ; Coronary Vessel Anomalies - diagnostic imaging ; Coronary Vessel Anomalies - pathology ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - pathology ; Female ; Fibromuscular Dysplasia - epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; Risk ; Vascular Diseases - complications ; Vascular Diseases - congenital ; Vascular Diseases - diagnostic imaging ; Vascular Diseases - pathology
Is Part Of: Circulation. Cardiovascular interventions, 2014-10, Vol.7 (5), p.656-662
Description: BACKGROUND—Spontaneous coronary artery dissection (SCAD) is an increasingly recognized nonatherosclerotic cause of acute coronary syndrome. The angiographic characteristics of SCAD are largely undetermined. The goal of this study was to determine the prevalence of coronary tortuosity in SCAD and whether it may be implicated in the disease. METHODS AND RESULTS—Patients with confirmed SCAD (n=246; 45.3±8.9 years; 96% women) and 313 control patients without SCAD or coronary artery disease who underwent coronary angiography were included in this case–control study. Angiograms were reviewed for coronary tortuosity and assigned a tortuosity score. Tortuosity was common in patients presenting with their first SCAD event (78% versus 17% in controls; P<0.0001; tortuosity score, 4.41±1.73 versus 2.33±1.49 in controls; P<0.0001) despite a low prevalence of hypertension (34%). Recurrent SCAD (n=40) occurred within segments of tortuosity in 80% of cases. Severe tortuosity (≥2 consecutive curvatures ≥180°) was associated with a higher risk of recurrent SCAD (hazard ratio, 3.29; 95% confidence interval, 0.99–8.29; P=0.05). Tortuosity score >5 was associated with a trend toward higher risk of recurrent SCAD (P=0.16). Prespecified angiographic markers of tortuosity including corkscrew appearance and multivessel symmetrical tortuosity were associated with extracoronary vasculopathy including fibromuscular dysplasia (P<0.05 for both). CONCLUSIONS—Coronary artery tortuosity is highly prevalent in the SCAD population and is associated with recurrent SCAD. Recurrent SCAD most often occurs within segments of tortuosity. Angiographic features of SCAD are associated with extracoronary vasculopathy, including fibromuscular dysplasia. These findings suggest that coronary tortuosity may serve as a marker or potential mechanism for SCAD.
Publisher: United States: American Heart Association, Inc
Language: English
Identifier: ISSN: 1941-7640
EISSN: 1941-7632
DOI: 10.1161/CIRCINTERVENTIONS.114.001676
PMID: 25138034
Source: MEDLINE
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Coronary Artery Tortuosity in Spontaneous Coronary Artery Dissection: Angiographic Characteristics and Clinical Implications

2014 American Heart Association, Inc. ;ISSN: 1941-7640 ;EISSN: 1941-7632 ;DOI: 10.1161/CIRCINTERVENTIONS.114.001676 ;PMID: 25138034

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