Differences in revascularization strategy and outcomes in ST-elevation and non-ST-elevation myocardial infarction with spontaneous coronary artery dissection
Notice bibliographique
Résumé
Abstract Background Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in young to middle-aged women. However, the role of revascularization for SCAD, especially percutaneous coronary intervention (PCI), remains controversial. Purpose To compare revascularization strategies and outcomes in SCAD patients presenting with ST-elevation MI (STEMI) vs. unstable angina or non-STEMI (UA/NSTEMI). Methods We analyzed SCAD patients who presented acutely between June 2014 and June 2018 to 22 centers participating in the Canadian SCAD Cohort Study. We compared treatment patterns and clinical outcomes in SCAD patients with an initial clinical presentation of STEMI vs. UA/NSTEMI. We assessed follow-up major adverse cardiovascular event (MACE) rate, a composite of all-cause death, MI, and stroke. The impact of revascularization on MACE was also evaluated according to clinical presentations (STEMI vs. UA/NSTEMI). Results Among 750 SCAD patients (mean age 51.7±10.5 years; 88.5% were women), 234 (31.2%) presented with STEMI. In the STEMI group, left anterior descending artery was more commonly involved (62.0% vs. 47.5%, p<0.001) and TIMI 0 flow was more frequently observed (24.8% vs. 7.2%, p<0.001). A total of 27.8% of STEMI patients were treated with revascularization (98.5% PCI), whereas only 8.7% of UA/NSTEMI patients were revascularized (93.3% PCI). For STEMI patients, 93.9% were planned procedures, whereas, for UA/NSTEMI patients, 71.1% were planned revascularization. Successful or partially successful PCI was 65.5% for STEMI and 76.9% for UA/NSTEMI (p<0.001). The median follow-up period was 850 (interquartile range: 619–1096) days. MACE rate was not different between STEMI and UA/NSTEMI (UA/NSTEMI as a reference: hazard ratio [HR] 1.08, 95% confidence interval [CI] 0.70–1.68, p=0.72). Regardless of clinical presentations, revascularization was associated with increased risk of MACE (STEMI: HR 2.57, CI 1.25–5.25, p=0.01; UA/NSTEMI: HR 5.41, CI 3.19–9.19, p<0.001). The association of revascularization and increased risk of MACE was more prominent in UA/NSTEMI than in STEMI (Figure), but it did not reach statistical significant (P for interaction = 0.09). Conclusions In SCAD patients, long-term clinical outcome was not different between STEMI and UA/NSTEMI presentations. Revascularization was more frequently performed with STEMI; however, regardless of clinical presentations, revascularization was associated with worse clinical outcomes. Careful patient selection for revascularization is key for SCAD patients and further studies are needed to clarify selection criteria. Revasc and MACE by presentation Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».