Trends of Incidence, Clinical Presentation, and In-Hospital Mortality Among Women With Acute Myocardial Infarction With or Without Spontaneous Coronary Artery Dissection: A Population-Based Analysis

JACC Cardiovasc Interv. 2018 Jan 8;11(1):80-90. doi: 10.1016/j.jcin.2017.08.016. Epub 2017 Dec 13.

Abstract

Objectives: The authors sought to determine the clinical characteristics and in-hospital survival of women presenting with acute myocardial infarction (AMI) and spontaneous coronary artery dissection (SCAD).

Background: The clinical presentation and in-hospital survival of women with AMI and SCAD remains unclear.

Methods: The National Inpatient Sample (2009 to 2014) was queried for all women with a primary diagnosis of AMI and concomitant SCAD. Iatrogenic coronary dissection was excluded. The main outcome was in-hospital mortality. Propensity score matching and multivariable logistic regression analyses were performed.

Results: Among 752,352 eligible women with AMI, 7,347 had a SCAD diagnosis. Women with SCAD were younger (61.7 vs. 67.1 years of age) with less comorbidity. SCAD was associated with higher incidence of in-hospital mortality (6.8% vs. 3.4%). In SCAD patients, a decrease in in-hospital mortality was evident with time (11.4% in 2009 vs. 5.0% in 2014) and concurred with less percutaneous coronary intervention (PCI) (82.5% vs. 69.1%). Propensity score yielded 7,332 SCAD and 14,352 patients without SCAD. The odds ratio (OR) of in-hospital mortality remained higher with SCAD after propensity matching (OR: 1.87, 95% confidence interval [CI]: 1.65 to 2.11) and on multivariable regression analyses (OR: 2.41, 95% CI: 2.07 to 2.80). PCI was associated with higher mortality in SCAD patients presenting with non-ST-segment elevation myocardial infarction (OR: 2.01; 95% CI: 1.00 to 4.47), but not with STEMI (OR: 0.62; 95% CI: 0.41 to 0.96).

Conclusions: Women presenting with AMI and SCAD appear to be at higher risk of in-hospital mortality. Lower rates of PCI were associated with improved survival, with evidence of worse outcomes when PCI was performed for SCAD in the setting of non with ST-segment elevation myocardial infarction.

Keywords: acute coronary syndrome(s); mortality; propensity score matching; women.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Coronary Angiography
  • Coronary Vessel Anomalies / diagnostic imaging
  • Coronary Vessel Anomalies / mortality*
  • Coronary Vessel Anomalies / surgery
  • Databases, Factual
  • Female
  • Hospital Mortality / trends*
  • Humans
  • Incidence
  • Middle Aged
  • Non-ST Elevated Myocardial Infarction / diagnostic imaging
  • Non-ST Elevated Myocardial Infarction / mortality*
  • Non-ST Elevated Myocardial Infarction / surgery
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / mortality
  • Percutaneous Coronary Intervention / trends
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • ST Elevation Myocardial Infarction / diagnostic imaging
  • ST Elevation Myocardial Infarction / mortality*
  • ST Elevation Myocardial Infarction / surgery
  • Sex Factors
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology
  • Vascular Diseases / congenital*
  • Vascular Diseases / diagnostic imaging
  • Vascular Diseases / mortality
  • Vascular Diseases / surgery

Supplementary concepts

  • Coronary Artery Dissection, Spontaneous