Spontane Koronardissektion - Unispital Basel

Spontane

KoronardissektionSpontaneous Coronary

Artery Dissection (SCAD)

PD Dr. med. Micha T. MaederKardiologie Kantonsspital St. Gallen

micha.maeder@kssg.ch

SCAD

•Nicht-atherosklerotische Form

der KHK

• Präsentation als ACS

• Vorwiegend Frauen betroffen

• Zwei Populationen• Assoziiert mit Schwangerschaft (P-

SCAD)

• Nicht-assoziiert mit Schwangerschaft

SCAD

•Pathophysiologie

•Diagnose

•Differentialdiagnose

•Management

•Prognose

Adlam D et al. Eur Heart J 2018

Adlam D et al. Eur Heart J 2018

Adlam D et al. Eur Heart J 2018

Klinische Charakteristika

Adlam D et al. Eur Heart J 2018

Prädisposition

Adlam D et al. Eur Heart J 2018

FMD

Adlam D et al. Eur Heart J 2018

Auslöser

SCAD

•Pathophysiologie

•Diagnose

•Differentialdiagnose

•Management

•Prognose

Saw J et al. Eur Heart 2019

Klinische Präsentation

EKG

Typ 1 SCAD

Saw J. Cathet Cardiovasc Interv 2013

Typ 2 SCAD

Saw J. Cathet Cardiovasc Interv 2013

Typ 3 SCAD

Saw J. Cathet Cardiovasc Interv 2013

Saw J et al. JACC 2016

Saw J et al. Eur Heart J 2019

Elkayam&Havakuk. JACC 2018

Saw J et al. Eur Heart J 2018

Adlam D et al. Eur Heart J 2018

SCAD

•Pathophysiologie

•Diagnose

•Differentialdiagnose

•Management

•Prognose

12.02.2019

SCAD

•Pathophysiologie

•Diagnose

•Differentialdiagnose

•Management

•Prognose

Saw J et al. JACC 2017

SCAD: med. Therapie

•Duale Tc-Hemmung

•Heparin einige Tage

•Statin

•ACE-Hemmer

•Betablocker

All patients (n=64)

CABG (n=1) PCI (n=7)

Peri-

proceduraldeath (n=1)

Medical therapy (n=56)

NSTEMI, FU

angio with

SCAD of

another vessel

(n=3)

Out-of-hospital

cardiac arrest 16

days after index

event, FU angio

with persistent

dissection (n=1)

FU angio

with good

PCI result

(n=4)

No events during

long-term FU

(n=1)No events during long-

term FU (n=6)

Procedural

success

(n=6)

FU angio

with

healed

dissection

(n=31)

FU angio

with

persistent

dissection

(n=1)

No FU angio(n=2)

No FU

angio

(n=20)

No events during long-

term FU (n=52)

Rogowski&Maeder et al. Cathet Cardiovasc Interv 2017

Saw J et al. Eur Heart J 2019

Saw J et al. Circ Cardiovasc Interv 2014

Saw J et al. JACC

2017

SCAD

•Pathophysiologie

•Diagnose

•Differentialdiagnose

•Management

•Prognose

Saw J et al. Eur Heart J 2019

n=750

Tweet MS et al. Circ CV

Interv 2014

Adlam D et al. Eur Heart J 2018

Rogowski&Maeder et al. Cathet Cardiovasc Interv 2017

SCAD

•Pathophysiologie

•Diagnose

•Differentialdiagnose

•Management

•Prognose

Vielen Dank!

Micha T. Maeder

micha.maeder@kssg.ch