Recurrent spontaneous coronary artery dissection in the United States

Chayakrit Krittanawong; Anirudh Kumar; Hafeez Ul Hassan Virk; Zhen Wang; Kipp W. Johnson; Bing Yue; Deepak L. Bhatt

doi:10.1016/j.ijcard.2019.10.052

Recurrent spontaneous coronary artery dissection in the United States

Chayakrit Krittanawong, Anirudh Kumar, Hafeez Ul Hassan Virk, Zhen Wang, Kipp W. Johnson, Bing Yue, Deepak L. Bhatt

Quantitative Health Sciences

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Background: Recurrent spontaneous coronary artery dissection (SCAD) is believed to be infrequent. Predictors of recurrent SCAD are poorly characterized. Methods: We evaluated the incidence, clinical characteristics, and predictors of recurrent SCAD using data from the Nationwide Readmissions Database from January 1, 2010, to December 30, 2016. Results: Among 1836 SCAD patients admitted with the primary diagnosis of SCAD (61.9% female, mean age 56.1 ± 14.5, 72.9% <65 years of age), 495 patients (26.9%) had recurrent SCAD within 1 year (74.0% female, 74% <65 years of age). Multivariable analysis showed that female sex (OR 2.09; 95% CI 1.49–2.95; p < 0.001) was an independent predictor of recurrent SCAD within 1 year. Conclusions: Recurrent SCAD is frequent and should be considered in younger females with a history of SCAD. Further research is needed to investigate the mechanistic links between female sex and recurrent SCAD.

Original language	English (US)
Pages (from-to)	34-37
Number of pages	4
Journal	International Journal of Cardiology
Volume	301
DOIs	https://doi.org/10.1016/j.ijcard.2019.10.052
State	Published - Feb 15 2020

Keywords

Recurrent spontaneous coronary artery dissection
SCAD
Spontaneous coronary artery dissection

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.ijcard.2019.10.052

Cite this

@article{5e53bc9b15754127a2c1eaaf1f42bec8,

title = "Recurrent spontaneous coronary artery dissection in the United States",

abstract = "Background: Recurrent spontaneous coronary artery dissection (SCAD) is believed to be infrequent. Predictors of recurrent SCAD are poorly characterized. Methods: We evaluated the incidence, clinical characteristics, and predictors of recurrent SCAD using data from the Nationwide Readmissions Database from January 1, 2010, to December 30, 2016. Results: Among 1836 SCAD patients admitted with the primary diagnosis of SCAD (61.9% female, mean age 56.1 ± 14.5, 72.9% <65 years of age), 495 patients (26.9%) had recurrent SCAD within 1 year (74.0% female, 74% <65 years of age). Multivariable analysis showed that female sex (OR 2.09; 95% CI 1.49–2.95; p < 0.001) was an independent predictor of recurrent SCAD within 1 year. Conclusions: Recurrent SCAD is frequent and should be considered in younger females with a history of SCAD. Further research is needed to investigate the mechanistic links between female sex and recurrent SCAD.",

keywords = "Recurrent spontaneous coronary artery dissection, SCAD, Spontaneous coronary artery dissection",

author = "Chayakrit Krittanawong and Anirudh Kumar and Virk, {Hafeez Ul Hassan} and Zhen Wang and Johnson, {Kipp W.} and Bing Yue and Bhatt, {Deepak L.}",

note = "Funding Information: Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, Cereno Scientific, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org ; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Medtelligence/ReachMD (CME steering committees), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co‑leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, Novo Nordisk, PLx Pharma, Takeda. None of the other authors have any disclosures. Funding Information: The study cohort was derived from Healthcare Cost and Utilization Project's (HCUP) National Readmission Database (NRD) between 2010 and 2016, sponsored by the Agency for Healthcare Research and Quality [ 9 ]. The NRD is one of the largest publicly available all-payer inpatient care databases from 22 states in the United States (data on approximately a sample size of 13 to 15 million discharges per year). National estimates were produced using sampling weights provided by the Agency for Healthcare Research and Quality [ 10 ]. We identified SCAD from the principle diagnosis in the NRD database using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code (414.12) from January 2010 to September 2015 and the ICD-10-CM diagnostic code (I25.42) from October 2015 to December 2016. We then assessed for a concurrent diagnosis of acute coronary syndrome (ACS) defined as ST-elevation myocardial infarction (STEMI) (ICD-CM 9 codes of 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.81, 410.91 and ICD-CM 10 codes of I21.3), non-ST elevation myocardial infarction (NSTEMI) (ICD-9-CM code of 410.7x and ICD-10-CM codes of I21.4), or unstable angina (ICD-CM 9 code 411.1 and ICD-10-CM codes of I20.x). In order to ensure the diagnosis of SCAD (ICD-9-CM 414.12), we included only patients with a procedural diagnosis of coronary angiography (ICD-9-CM codes of 88.53, 88.54, 88.55, 88.56, 37.22, or 37.23 and ICD-10-CM codes of Y84.0) and/or percutaneous coronary intervention (PCI) (ICD-9-CM codes of 00.66, 36.01, 36.02, 36.05, 36.06, or 36.07 and ICD-10-PCS 10 codes of 02703xx, 02713xx, 02723xx, and 02733xx) and excluded iatrogenic accidental puncture or laceration (ICD-9-CM codes of 998.2 and ICD-10-CM codes of I97.51). We excluded patients with age <18 years and those missing data for age, sex, or mortality. We identified recurrent SCAD as patients with a history of SCAD who were readmitted for SCAD as the principal diagnosis within 1 year. To accurately extract patients with a diagnosis of recurrent SCAD, we excluded patients with a secondary diagnosis of SCAD who were likely to include patients with persistent SCAD or those without complete resolution of the hematoma. The primary outcome of our study was incidence of recurrent SCAD and the secondary outcome was predictors of recurrent SCAD. Patients' demographic characteristics were extracted including age and sex, primary payer, and co-morbidities such as hypertension, pulmonary hypertension, atrial fibrillation, heart failure (HF), chronic obstructive pulmonary disease (COPD), peripheral artery disease (PAD), obesity, diabetes mellitus, anemia, neurological disease, malignancy, and kidney diseases using the associated ICD-9-CM and ICD-10-CM codes. Infrequent events were not included due to data agreements [ 10 ]. Demographics, conventional risk factors, socioeconomic factors, medical management, and in-hospital outcomes were evaluated. Percentages and means ± standard deviations were computed for categorical and continuous variables, respectively. Categorical variables were compared using the Chi-squared test or Fisher's exact test, when appropriate, while continuous variables were analyzed using the 2-tailed Student's t -Test or the Mann–Whitney- U test, when appropriate. Univariable and multivariable logistic regression modeling were performed to determine predictors associated with recurrent SCAD. All analyses were conducted using R 3.4.0 and Stata version 14.2. All p-values were two-sided and statistical significance was determined at the level of p < 0.05. 3 Funding Information: None. There was no funding for this work. Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, Cereno Scientific, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Medtelligence/ReachMD (CME steering committees), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co‑leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, Novo Nordisk, PLx Pharma, Takeda. None of the other authors have any disclosures. Publisher Copyright: {\textcopyright} 2019 Elsevier B.V.",

year = "2020",

month = feb,

day = "15",

doi = "10.1016/j.ijcard.2019.10.052",

language = "English (US)",

volume = "301",

pages = "34--37",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Recurrent spontaneous coronary artery dissection in the United States

AU - Krittanawong, Chayakrit

AU - Kumar, Anirudh

AU - Virk, Hafeez Ul Hassan

AU - Wang, Zhen

AU - Johnson, Kipp W.

AU - Yue, Bing

AU - Bhatt, Deepak L.

N1 - Funding Information: Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, Cereno Scientific, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org ; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Medtelligence/ReachMD (CME steering committees), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co‑leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, Novo Nordisk, PLx Pharma, Takeda. None of the other authors have any disclosures. Funding Information: The study cohort was derived from Healthcare Cost and Utilization Project's (HCUP) National Readmission Database (NRD) between 2010 and 2016, sponsored by the Agency for Healthcare Research and Quality [ 9 ]. The NRD is one of the largest publicly available all-payer inpatient care databases from 22 states in the United States (data on approximately a sample size of 13 to 15 million discharges per year). National estimates were produced using sampling weights provided by the Agency for Healthcare Research and Quality [ 10 ]. We identified SCAD from the principle diagnosis in the NRD database using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code (414.12) from January 2010 to September 2015 and the ICD-10-CM diagnostic code (I25.42) from October 2015 to December 2016. We then assessed for a concurrent diagnosis of acute coronary syndrome (ACS) defined as ST-elevation myocardial infarction (STEMI) (ICD-CM 9 codes of 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.81, 410.91 and ICD-CM 10 codes of I21.3), non-ST elevation myocardial infarction (NSTEMI) (ICD-9-CM code of 410.7x and ICD-10-CM codes of I21.4), or unstable angina (ICD-CM 9 code 411.1 and ICD-10-CM codes of I20.x). In order to ensure the diagnosis of SCAD (ICD-9-CM 414.12), we included only patients with a procedural diagnosis of coronary angiography (ICD-9-CM codes of 88.53, 88.54, 88.55, 88.56, 37.22, or 37.23 and ICD-10-CM codes of Y84.0) and/or percutaneous coronary intervention (PCI) (ICD-9-CM codes of 00.66, 36.01, 36.02, 36.05, 36.06, or 36.07 and ICD-10-PCS 10 codes of 02703xx, 02713xx, 02723xx, and 02733xx) and excluded iatrogenic accidental puncture or laceration (ICD-9-CM codes of 998.2 and ICD-10-CM codes of I97.51). We excluded patients with age <18 years and those missing data for age, sex, or mortality. We identified recurrent SCAD as patients with a history of SCAD who were readmitted for SCAD as the principal diagnosis within 1 year. To accurately extract patients with a diagnosis of recurrent SCAD, we excluded patients with a secondary diagnosis of SCAD who were likely to include patients with persistent SCAD or those without complete resolution of the hematoma. The primary outcome of our study was incidence of recurrent SCAD and the secondary outcome was predictors of recurrent SCAD. Patients' demographic characteristics were extracted including age and sex, primary payer, and co-morbidities such as hypertension, pulmonary hypertension, atrial fibrillation, heart failure (HF), chronic obstructive pulmonary disease (COPD), peripheral artery disease (PAD), obesity, diabetes mellitus, anemia, neurological disease, malignancy, and kidney diseases using the associated ICD-9-CM and ICD-10-CM codes. Infrequent events were not included due to data agreements [ 10 ]. Demographics, conventional risk factors, socioeconomic factors, medical management, and in-hospital outcomes were evaluated. Percentages and means ± standard deviations were computed for categorical and continuous variables, respectively. Categorical variables were compared using the Chi-squared test or Fisher's exact test, when appropriate, while continuous variables were analyzed using the 2-tailed Student's t -Test or the Mann–Whitney- U test, when appropriate. Univariable and multivariable logistic regression modeling were performed to determine predictors associated with recurrent SCAD. All analyses were conducted using R 3.4.0 and Stata version 14.2. All p-values were two-sided and statistical significance was determined at the level of p < 0.05. 3 Funding Information: None. There was no funding for this work. Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, Cereno Scientific, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Medtelligence/ReachMD (CME steering committees), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co‑leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, Novo Nordisk, PLx Pharma, Takeda. None of the other authors have any disclosures. Publisher Copyright: © 2019 Elsevier B.V.

PY - 2020/2/15

Y1 - 2020/2/15

N2 - Background: Recurrent spontaneous coronary artery dissection (SCAD) is believed to be infrequent. Predictors of recurrent SCAD are poorly characterized. Methods: We evaluated the incidence, clinical characteristics, and predictors of recurrent SCAD using data from the Nationwide Readmissions Database from January 1, 2010, to December 30, 2016. Results: Among 1836 SCAD patients admitted with the primary diagnosis of SCAD (61.9% female, mean age 56.1 ± 14.5, 72.9% <65 years of age), 495 patients (26.9%) had recurrent SCAD within 1 year (74.0% female, 74% <65 years of age). Multivariable analysis showed that female sex (OR 2.09; 95% CI 1.49–2.95; p < 0.001) was an independent predictor of recurrent SCAD within 1 year. Conclusions: Recurrent SCAD is frequent and should be considered in younger females with a history of SCAD. Further research is needed to investigate the mechanistic links between female sex and recurrent SCAD.

AB - Background: Recurrent spontaneous coronary artery dissection (SCAD) is believed to be infrequent. Predictors of recurrent SCAD are poorly characterized. Methods: We evaluated the incidence, clinical characteristics, and predictors of recurrent SCAD using data from the Nationwide Readmissions Database from January 1, 2010, to December 30, 2016. Results: Among 1836 SCAD patients admitted with the primary diagnosis of SCAD (61.9% female, mean age 56.1 ± 14.5, 72.9% <65 years of age), 495 patients (26.9%) had recurrent SCAD within 1 year (74.0% female, 74% <65 years of age). Multivariable analysis showed that female sex (OR 2.09; 95% CI 1.49–2.95; p < 0.001) was an independent predictor of recurrent SCAD within 1 year. Conclusions: Recurrent SCAD is frequent and should be considered in younger females with a history of SCAD. Further research is needed to investigate the mechanistic links between female sex and recurrent SCAD.

KW - Recurrent spontaneous coronary artery dissection

KW - SCAD

KW - Spontaneous coronary artery dissection

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U2 - 10.1016/j.ijcard.2019.10.052

DO - 10.1016/j.ijcard.2019.10.052

M3 - Article

C2 - 31757645

AN - SCOPUS:85076202449

SN - 0167-5273

VL - 301

SP - 34

EP - 37

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Recurrent spontaneous coronary artery dissection in the United States

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