RESUMEN
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS); however, its detection carries relevant clinical implications. Cardiac computed tomography (CCT) has been found to be useful for follow-up, but data during the acute phase are scarce. Thus, our aim was to evaluate the early diagnostic ability of CCT to detect SCAD. METHODS: We retrospectively analyzed all the in-hospital CCT performed in a prospective cohort of patients with SCAD from 2012 to 2016. An independent expert blindly evaluated the studies and described the radiologic characteristics of the lesions. These features were compared with the invasive coronary angiography (ICA) and optical coherence tomography (OCT) findings. RESULTS: 18 lesions were analyzed from 12 episodes identified in 11 patients (100% females; median age of 57 years old). CCT recognized the presence of SCAD in 14 (78%) of the lesions, with four different morphological patterns. Most commonly (10, 71%) SCAD presented as a diffuse lumen narrowing surrounded by a 'sleeve-like' wall thickening, which corresponded to intramural hematoma in OCT evaluation. When compared with ICA, CCT showed a positive correlation (Spearman's Rho = 0.775; P = 0.001) and excellent concordance (ICC = 0.8; P = 0.004) in stenosis grading, but not for lesion length and minimal luminal area. CONCLUSION: CCT was able to identify the presence of SCAD in most of the patients in the acute phase of this elusive and challenging clinical entity. In addition, in this setting, CCT revealed unique and distinct radiologic features and provided a precise assessment of lesion severity.
Asunto(s)
Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Tomografía de Coherencia Óptica , Tomografía Computarizada por Rayos X , Enfermedades Vasculares/congénito , Estudios de Cohortes , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/fisiopatología , Femenino , Humanos , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/etiología , Infarto del Miocardio sin Elevación del ST/fisiopatología , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/etiología , Infarto del Miocardio con Elevación del ST/fisiopatología , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/fisiopatologíaRESUMEN
INTRODUCTION AND OBJECTIVES: Tako-tsubo syndrome is a potentially serious disease during the acute phase. It mimics myocardial infarction, but with no potentially causative coronary lesions. The aim of this study was to analyze the clinical course and outcome of patients with tako-tsubo syndrome by sex. METHODS: We analyzed the characteristics of patients included in the RETAKO registry from 2003 to 2015, a multicenter registry with participation of 32 Spanish hospitals. RESULTS: Of 562 patients included, 493 (87.7%) were women. Chest pain was less frequent as an initial symptom in men than in women (43 [66.2%] vs 390 [82.8%]; P < .01). The prognosis was worse in men, with higher in-hospital mortality (3 [4.4%] vs 1 [0.2%]; P < .01), longer intensive care stay (4.2 ± 3.7 vs 3.2 ± 3.2 days; P = .03) and a higher frequency of severe heart failure (22 [33.3%] vs 95 [20.3%]; P = .02). However, dynamic obstruction at the left-ventricular outflow tract occurred exclusively in women (39 [7.9%] vs 0 [0.0%]; P = .02). The incidence of functional mitral regurgitation was also higher in women (52 [10.6%] vs 2 [2.9%]; P = .04). CONCLUSIONS: Tako-tsubo syndrome shows wide differences by sex in terms of its incidence, presentation, and outcomes. Prognosis is worse in men.
Asunto(s)
Ventrículos Cardíacos/fisiopatología , Insuficiencia de la Válvula Mitral/epidemiología , Infarto del Miocardio/etiología , Cardiomiopatía de Takotsubo/epidemiología , Función Ventricular Izquierda/fisiología , Anciano , Angiografía Coronaria , Diagnóstico Diferencial , Progresión de la Enfermedad , Electrocardiografía , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/diagnóstico por imagen , Mortalidad Hospitalaria/tendencias , Humanos , Incidencia , Masculino , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/etiología , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Pronóstico , Estudios Retrospectivos , España/epidemiología , Cardiomiopatía de Takotsubo/complicaciones , Cardiomiopatía de Takotsubo/diagnósticoRESUMEN
Left ventricular free wall rupture (FWR) is a rare but dreadful complication after acute myocardial infarction (AMI). A coronary "milking-like" effect has been previously related to ventricular pseudoaneurysm or true aneurysm but not yet with other mechanical complications such as left ventricular FWR. We describe 2 patients with AMI showing a coronary milking-like effect in the infarct-related artery at the time of primary percutaneous coronary intervention. Left ventricular FWR eventually developed and the patients died. We propose that a coronary milking-like effect in the infarct-related artery is a marker of patients at high risk for this life-threatening mechanical complication.
Asunto(s)
Angiografía Coronaria , Rotura Cardíaca Posinfarto/diagnóstico , Ventrículos Cardíacos/lesiones , Infarto del Miocardio con Elevación del ST/complicaciones , Anciano , Anciano de 80 o más Años , Taponamiento Cardíaco/etiología , Resultado Fatal , Rotura Cardíaca Posinfarto/etiología , Humanos , Masculino , Derrame Pericárdico/etiología , Sístole , Troponina T/sangreRESUMEN
Neoatherosclerosis has been described as a cause of in-stent restenosis (ISR), particularly in patients treated with drug-eluting stents (DESs). Although neoatherosclerosis may present as calcified plaques, the occurrence of a "calcified nodule" within the stent has not been previously reported. We describe optical coherence tomographic findings in a patient presenting with a calcified nodule causing "undilatable" ISR 2 years after implantation of a DES. The clinical and technical implications of this novel pattern of neoatherosclerosis are discussed.