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      Disección coronaria espontánea. Primer reporte a nivel nacional Translated title: Dissecção coronariana espontânea. Primeiros relatórios em todo o país Translated title: Spontaneous coronary dissection. First nationwide report

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          Abstract

          Resumen: La disección coronaria espontánea (DCE) es una causa infrecuente de síndrome coronario agudo (SCA), de presentación principalmente en mujeres de mediana edad. Se realizó una revisión de la base de datos institucional, desde la incorporación en nuestro centro de tecnología para adquisición de imagen intracoronaria hasta la actualidad (julio de 2013 a diciembre de 2019). Se encontró DCE en 13 de 4.706 coronariografías diagnósticas (0,3%). Presentamos angiografía y ultrasonografía intracoronaria (IVUS) representativa de lo observado en la serie. La edad media de presentación fue 52 ± 14 años, 11 de los 13 casos eran mujeres. El tiempo medio de seguimiento fue 39 ±27 meses. La forma clínica de presentación más frecuente fue SCA sin elevación del ST (6/13). El vaso más frecuentemente afectado fue la arteria descendente anterior (n=8). En todos los casos se registró elevación significativa de troponinas (> percentil 99). Se realizó tratamiento conservador en 11 casos y angioplastia exitosa en dos. Un paciente que recibió tratamiento conservador falleció durante la internación. Se requirió de imagenología intracoronaria en nueve de los 13 casos. Se presenta el primer reporte nacional de DCE, describiendo sus características clínicas, imagenológicas, tratamiento y evolución.

          Translated abstract

          Resumo: A dissecção coronariana espontânea é uma causa pouco frequente da síndrome coronariana aguda, principalmente em mulheres de meia idade. Realizamos uma revisão do banco de dados de nosso centro a partir da data de aquisição das técnicas de imagem intracoronária em nosso laboratório (julho de 2013 a dezembro de 2019). Dissecção coronariana espontânea foi encontrada em 13 pacientes de 4706 angiografias coronárias diagnósticas (0,3%). Apresentamos angiografia coronariana representativa e estudos ultrassonográficos desta série de casos. A idade média de apresentação foi de 52 ± 14 anos, 11 dos 13 casos eram do sexo feminino. O tempo médio de acompanhamento foi de 39 ± 27 meses. A apresentação clínica mais frequente foi síndrome coronariana aguda sem supradesnivelamento do segmento ST 6/13. O vaso mais acometido foi a artéria descendente anterior (n = 8). Em todos os casos, as troponinas foram encontradas acima de 99%. O tratamento conservador foi realizado em 11 casos e a angioplastia em 2, com sucesso. Um paciente em tratamento conservador morreu durante a internação. O uso de imagens intracoronárias foi necessário em 9 dos 13 casos. Concluindo, relatamos, pela primeira vez, um registro nacional de dissecção coronariana espontânea de que descreve suas características clínicas, de imagem, de tratamento e de evolução.

          Translated abstract

          Summary: Spontaneous coronary dissection is an infrequent cause of acute coronary syndrome, particularly in middle-aged women. We made review of the database of our center since the date of acquisition of intracoronary imaging techniques in our laboratory (July 2013 - December 2019). Coronary spontaneous dissection was found in 13 patients of 4706 diagnostic coronary angiograms (0.3%). We present angiography and coronary ultrasonography studies representative of this case series. The mean age of presentation was 52 ± 14 years, 11 of 13 of the cases were women. The mean follow-up time was 39 ± 27 months. The most frequent clinical presentation was acute coronary syndrome without ST elevation 6/13. The most frequently affected vessel was the anterior descending artery (n = 8). In all cases, troponins above the 99 percent were found. Conservative treatment was performed in 11 cases and successful angioplasty in the other two cases. One patient under conservative treatment died during hospitalization. The use of intracoronary imaging was required in 9 of the 13 cases. In conclusion, we present for the first time, a national registry of spontaneous coronary dissection describing its clinical, image, treatment and evolution characteristics.

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          Most cited references 10

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          Clinical features, management, and prognosis of spontaneous coronary artery dissection.

          Spontaneous coronary artery dissection (SCAD) is an acute coronary event of uncertain origin. Clinical features and prognosis remain insufficiently characterized.
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            Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes.

            Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described.
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              Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a "conservative" therapeutic strategy.

              This study sought to assess the long-term clinical outcome of patients with spontaneous coronary artery dissection (SCD) managed with a conservative strategy.
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                Author and article information

                Journal
                ruc
                Revista Uruguaya de Cardiología
                Rev.Urug.Cardiol.
                Sociedad Uruguaya de Cardiología (Montevideo, , Uruguay )
                0797-0048
                1688-0420
                2020
                : 35
                : 1
                : 131-149
                Affiliations
                Montevideo orgnameHospital de Clínicas orgdiv1Centro Cardiovascular Universitario orgdiv2Servicio de Hemodinamia Uruguay r1000a@ 123456gmail.com
                Article
                S1688-04202020000100131 S1688-0420(20)03500100131
                10.29277/cardio.35.1.8

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 19
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