Publication: Diagnóstico y manejo clínico de la disección coronaria espontánea
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2022-10-25
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Universidad Complutense de Madrid
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Abstract
La disección coronaria espontánea (DCE) es una patología que causa síndrome coronario agudo generalmente en mujeres de mediana edad. Se produce por la separación de las capas de la arteria coronaria con creación de un falso lumen que compromete el flujo sanguíneo normal causando isquemia miocárdica. Existen muchas incógnitas en cuanto a la etiología, elementos de diagnóstico y manejo clínico de esta enfermedad. La presente tesis trata de responder a diferentes cuestiones clínicas relacionadas con la DCE a través de estudios de cohortes y registros multicéntricos internacionales de pacientes con esta enfermedad. Primeramente, mediante una revisión narrativa se realizará un repaso actualizado sobre el estado del arte de la enfermedad haciendo hincapié en las áreas de incertidumbre que competen a los estudios presentados. Seguidamente, se presentarán los 4 estudios originales de investigación que integran el cuerpo de esta tesis y que estudian los siguientes aspectos: i) diferencias en la semiología y pronóstico del síndrome Takotsubo y la DCE en pacientes con una presentación clínica compatible con ambos síndromes; ii) relación entre las diferentes presentaciones angiográficas (angiotipos) de la DCE y el desarrollo de eventos adversos clínicos a corto y largo plazo; iii) efectividad y seguridad alargo plazo de los stents bioabsorbibles en pacientes con DCE de alto riesgo que precisan revascularización coronaria; iv) empleo de la resonancia magnética vascular como técnica de imagen en el estudio de arteriopatía no coronaria en pacientes con DCE...
Spontaneous coronary artery dissection (SCAD) is a disease that causes acute coronary syndromes mainly in middle-aged women. It isproduced by the separation of the arterial wall layers and the formation of a false lumen provoking myocardial ischaemia. There are many uncertainties regarding the causes, diagnostic features and clinical management of this disease. The present thesis aims to answer to different clinical questions through the study of cohorts and multicentre international registries of patients with SCAD. Firstly, the state of the art of the disease will be reviewed focusing on the gaps in evidence that are addressed with the studies presented hereby. Following this, 4 original research articles will be presented, which have their focuses in the following topics: i) differences in clinical presentation and prognosis between Takotsubo syndrome and SCAD in patients with common clinical profile i.e. middle-aged, predominantly women with few cardiovascular risk factors; ii) relationship of the distinct angiographic presentations (angiotypes) of SCAD with short- and long-term clinical outcomes; iii) long-term effectiveness and safety of bioresorbable stents in patients with high-risk SCAD undergoing percutaneous angioplasty; iv) use of magnetic resonance angiography for the study of non-coronary arteriopathy in patients with SCAD...
Spontaneous coronary artery dissection (SCAD) is a disease that causes acute coronary syndromes mainly in middle-aged women. It isproduced by the separation of the arterial wall layers and the formation of a false lumen provoking myocardial ischaemia. There are many uncertainties regarding the causes, diagnostic features and clinical management of this disease. The present thesis aims to answer to different clinical questions through the study of cohorts and multicentre international registries of patients with SCAD. Firstly, the state of the art of the disease will be reviewed focusing on the gaps in evidence that are addressed with the studies presented hereby. Following this, 4 original research articles will be presented, which have their focuses in the following topics: i) differences in clinical presentation and prognosis between Takotsubo syndrome and SCAD in patients with common clinical profile i.e. middle-aged, predominantly women with few cardiovascular risk factors; ii) relationship of the distinct angiographic presentations (angiotypes) of SCAD with short- and long-term clinical outcomes; iii) long-term effectiveness and safety of bioresorbable stents in patients with high-risk SCAD undergoing percutaneous angioplasty; iv) use of magnetic resonance angiography for the study of non-coronary arteriopathy in patients with SCAD...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 26-05-2022