|
|
(40 intermediate revisions by 2 users not shown) |
Line 1: |
Line 1: |
| __NOTOC__
| | ==Definition of Multivessel Disease== |
| {{Spontaneous coronary artery dissection}}
| |
|
| |
|
| <div style="font-size: 80%;" align="center">
| | For AEGIS-II inclusion criteria #5, multivessel disease criteria can be met by findings on the cardiac catheterization for the index MI, a prior cardiac catheterization, or both: |
| | | * Index MI cardiac catheterization: 50% or greater stenosis of the left main or at least <b><u>2</u></b> coronary artery territories (LAD, LCX, RCA) (prior to any interventions performed) |
| <span style="font-size: 1.5em; font-weight: bold;">Algorithm for the Angiographic Diagnosis and Confirmation of Spontaneous Coronary Artery Dissection</span><ref name="pmid24227590">{{cite journal| author=Saw J| title=Coronary angiogram classification of spontaneous coronary artery dissection. | journal=Catheter Cardiovasc Interv | year= 2014 | volume= 84 | issue= 7 | pages= 1115-22 | pmid=24227590 | doi=10.1002/ccd.25293 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24227590}}</ref><BR><BR>
| | * Prior cardiac catheterization: 50% or greater stenosis of left main or at least <b><u>2</u></b> coronary artery territories (LAD, LCx, RCA) (prior to any interventions performed) |
| | | * Both: Index MI cardiac catheterization with 1 vessel with 50% or greater stenosis (prior to any interventions performed) <b><u>AND</u></b> prior PCI of at least 1 vessel different from index MI vessel |
| {{Familytree/start}}
| | * Prior multivessel CABG |
| {{Familytree | | | | | A01 | | | | | | | | |
| |
| A01=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| <div class="mw-customtoggle-x1" style="cursor: pointer;> | |
| Presence of features that raise suspicion for SCAD?<BR><span style="color: #0645AD;">(click for details)</span>
| |
| </div> | |
| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x1" style="font-size: 10px;">
| |
| ----
| |
| ❑ [[Myocardial infarction]] in young women (especially age ≤50)
| |
| | |
| ❑ Absence of traditional [[Cardiovascular disease#Risk factors|cardiovascular risk factors]]
| |
| | |
| ❑ Little or no evidence of typical [[atherosclerosis|atherosclerotic lesions]] in coronary arteries
| |
| | |
| ❑ [[Peripartum|Peripartum state]]
| |
| | |
| ❑ History of [[fibromuscular dysplasia]]
| |
| | |
| ❑ History of relevant [[connective tissue disorder]] or [[Systemic inflammation|systemic inflammatory condition]]
| |
| | |
| ❑ [[Marfan's syndrome]]
| |
| | |
| ❑ [[Ehlers-Danlos syndrome|Ehlers-Danlos syndrome Type 4]]
| |
| | |
| ❑ [[Loeys-Dietz syndrome]]
| |
| | |
| ❑ [[Cystic medial necrosis]]
| |
| | |
| ❑ [[Systemic lupus erythematosus]]
| |
| | |
| ❑ [[Crohn's disease]]
| |
| | |
| ❑ [[Ulcerative colitis]]
| |
| | |
| ❑ [[Polyarteritis nodosa]]
| |
| | |
| ❑ [[Sarcoidosis]]
| |
| | |
| ❑ [[Churg-Strauss syndrome]]
| |
| | |
| ❑ [[Wegener's granulomatosis]]
| |
| | |
| ❑ [[Rheumatoid arthritis]]
| |
| | |
| ❑ [[Giant cell arteritis]]
| |
| ----
| |
| </div>
| |
| </div>}}
| |
| {{Familytree | | | | | |!| | | | | | | | | | }}
| |
| {{Familytree | | | | | B01 | | | | | | | | |
| |
| B01=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| Perform early coronary angiography
| |
| </div>}}
| |
| {{Familytree | | | | | |!| | | | | | | | | | }}
| |
| {{Familytree | | | | | C01 | | | | | | | | |
| |
| C01=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| <div class="mw-customtoggle-x2" style="cursor: pointer;>
| |
| Presence of type 1 SCAD lesion characteristics?<BR><span style="color: #0645AD;">(click for details)</span>
| |
| </div>
| |
| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x2" style="font-size: 10px;">
| |
| ----
| |
| ❑ Pathognomonic appearance of contrast dye staining of arterial wall
| |
| | |
| ❑ Multiple radiolucent lumens
| |
| | |
| ❑ ±Dye hang-up or slow contrast clearing from the lumen
| |
| ----
| |
| </div> | |
| </div>}} | |
| {{Familytree | |,|-|-|-|^|-|-|-|.| | | | | | }}
| |
| {{Familytree | D01 | | | | | | D02 | | | | |
| |
| D01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
| |
| D02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>
| |
| }}
| |
| {{Familytree | |!| | | | | | | |!| | | | | | }}
| |
| {{Familytree | E01 | | | | | | E02 | | | | |
| |
| E01=<div style="text-align: center; font-weight: bold; padding: 5px;">Type 1 SCAD most likely</div>|
| |
| E02=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| <div class="mw-customtoggle-x3" style="cursor: pointer;>
| |
| Presence of type 2 SCAD lesion characteristics?<BR><span style="color: #0645AD;">(click for details)</span>
| |
| </div>
| |
| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x3" style="font-size: 10px;">
| |
| ----
| |
| ❑ Diffuse lesion (typically >20–30 mm)
| |
|
| |
| ❑ Smooth luminal narrowing with varying severity
| |
| | |
| ❑ Involvement of mid to distal segments
| |
| ----
| |
| </div> | |
| </div> | |
| }}
| |
| {{Familytree | | | | | |,|-|-|-|^|-|-|-|.| | }}
| |
| {{Familytree | | | | | F01 | | | | | | F02 |
| |
| F01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
| |
| F02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>
| |
| }}
| |
| {{Familytree | | | | | |!| | | | | | | |!| | }}
| |
| {{Familytree | | | | | G01 | | | | | | G02 |
| |
| G01=<div style="text-align: left; font-weight: bold; padding: 5px;">Stenosis relieved by intracoronary nitroglycerin?</div>|
| |
| G02=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| <div class="mw-customtoggle-x4" style="cursor: pointer;>
| |
| Look for type 3 SCAD lesion characteristics<BR><span style="color: #0645AD;">(click for details)</span>
| |
| </div>
| |
| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x4" style="font-size: 10px;">
| |
| ----
| |
| ❑ Focal or tubular stenosis (typically <20 mm)
| |
| | | |
| ❑ Mimics atherosclerosis
| | Multivessel disease requires a 50% or greater stenosis in at least 2 of the 3 major epicardial artery territories (LAD, LCx, RCA) or the left main vessel. Branch vessel disease may qualify as part of the territory of that branch vessel (for example, a diagonal vessel is considered part of the LAD territory). For the purpose of this study, the ramus is considered part of the Left Circumflex artery territory. If a branch vessel is used as a qualifying vessel, that branch should be of large enough size to potentially undergo revascularization if clinically indicated, e.g. >2mm vessel size. |
| | |
| ❑ Additional features
| |
| | |
| ❑ No atherosclerosis in other arteries
| |
| | |
| ❑ Long lesions (11–20 mm)
| |
| | |
| ❑ Hazy stenosis
| |
| | |
| ❑ Linear stenosis
| |
| ----
| |
| </div>
| |
| </div>
| |
| }}
| |
| {{Familytree | |,|-|-|-|^|-|-|-|.| | | |!| | }}
| |
| {{Familytree | H01 | | | | | | H02 | | H03 |
| |
| H01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
| |
| H02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>|
| |
| H03=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| Type 3 SCAD most likely
| |
| | |
| ❑ Consider OCT or IVUS for definitive diagnosis
| |
| | |
| ❑ Reassess with angiography in 4 to 6 weeks
| |
| </div>
| |
| }}
| |
| {{Familytree | |!| | | | | | | |!| | | | | | }}
| |
| {{Familytree | I01 | | | | | | I02 | | | | |
| |
| I01=<div style="text-align: center; font-weight: bold; padding: 5px;">R/O coronary spasm or other conditions</div>|
| |
| I02=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| Type 2 SCAD most likely
| |
| | |
| ❑ Consider OCT or IVUS for definitive diagnosis
| |
|
| |
|
| ❑ Reassess with angiography in 4 to 6 weeks
| | ==MVD Tool== |
| </div>}}
| |
| {{Family tree/end}}
| |
| </div>
| |
|
| |
|
| ==References==
| | {| |
| {{reflist|2}} | | {{#Widget:MVD5}} |
| | |} |