Physiology of SCAD
Dissection
Hemorrhage into false lumen
Impingement of blood flow In the true lumen
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Ischemia
Epidemiology
Incidence of SCAD ranges from 0.2 - 1.1% of coronary angiograms
Incidence depends on study design, referral population, and the diagnostic tests utilized
Prevalence of SCAD
Vanzetto et al.
Used a prospective interventional cardiology laboratory database in France (2000-2006)
SCAD was defined on coronary angiography as:
The presence of an intimal flap with false lumen &/ or stagnation of contrast media in the coronary artery wall
Excluded PCI or trauma-related dissections
No IVUS performed
Identified 23 cases of 11,605 angiograms (0.2%)
Vanzetto et al. Eur J CT Surgery 2009;35:
Prevalence of SCAD
Hering et al.
Prospectively studied patients referred for cardiac catheterization between 1995-1997 in German hospitals
SCAD was defined on coronary angiography as:
The presence of an intimal flap with false lumen
If the lesion was ambiguous, may also be diagnosed by a flap visualized on IVUS (1/3rd of SCAD cases)
Identified 42 cases of 3803 angiograms
(1.1%)
Hering et al. Z Kardiol. 1998;87
Prevalence
are ne
Vanzetto et al. Eur J CT Surgery 2009;35:
Epidemiology
70% of SCAD occurs in women
RR of SCAD amongst all coronary angiograms is 9:1 for women:men
Among women, SCAD is more prevalent among younger patients (7.6% for <40 years versus 1.2% for >70 years)
Vanzetto et al. Eur J CT Surgery 2009;35:
Gender Differences
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Kamineni et al. Cardiology in Review 2002;10
Gender Differences
|
Female |
Male |
|
Age |
38 |
46 |
|
Average # |
|
|
|
risk |
1 |
2 |
|
factors |
|
|
|
Artery |
LAD (LM |
|
|
Involveme |
RCA |
||
and MV) |
|||
nt |
|
||
|
|
Vanzetto et al. Eur J CT Surgery 2009;35:
Etiology
De Maio et al. proposed three groups of patients predisposed to SCAD:
Established atherosclerosis (22-28% of
SCAD)
Peripartum
Idiopathic (without an identifiable predisposing factor)
More recently, a fourth group has emerged
Patients with underlying risk factors for dissection
De Maio et al. Am J Cardiol 1989;64:
Atherosclerosis & SCAD
Atherosclerosis
Plaque inflammation and
Subsequent plaque rupture
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Disruption of intimal-medial junction
reation of dissection flap (SCAD)