Talk:Spontaneous coronary artery dissection

What about iatrogenic coronary artery dissection

The article lead equates "coronary artery dissection" with "spontaneous coronary artery dissection", to the exclusion of iatrogenic coronary artery dissection (PMID 17015916). It's not clear to me whether it's better to broaden the article to include both terms, since they share some important features, or separate them. -- Scray (talk) 04:39, 4 November 2009 (UTC)

I have mentioned it under "causes" and added a ref. I haven't put a lot in but it can be added to. Jhbuk (talk) 15:28, 4 November 2009 (UTC)

My point is that this is upside-down in priority. Spontaneous coronary artery dissection is rare (according to the lead), whereas the iatrogenic form is common. Coronary angioplasty procedures are common, and up to 50% are complicated by coronary artery dissection (Baim, DS, Grossman, W. Complications of cardiac catheterization. In: Cardiac Catheterization, Angiography and Intervention, Baim, DS, Grossman, W (Eds), Williams & Wilkins, Baltimore 1996. p.17). I think this article's focus needs to be completely redone, with spontaneous coronary artery dissection treated as a rare special case. I'll do so when I get a chance if someone else doesn't do it first. -- Scray (talk) 22:54, 4 November 2009 (UTC)

I added an extra paragraph and a sentence in the lead, but the ref I used [1] stated that:"(with retrograde extension to the aortic root) between 0.008% and 0.02% of diagnostic catheterizations and 0.06% to 0.07% of percutaneous coronary interventions". It cited: (Perez-Castellano N, GarcÌa-Fernandez MA, GarcÌa EJ, Delcan JL. Dissection of the aortic sinus of valsalva complicating coronary catheterization: Cause, mechanism, evolution, and managemen. Cathet Cardiovasc Diagn 1998;43:273–279.) and (Carter AJ, Brinker JA. Dissection of the ascending aorta associated with coronary angiography. Am J Cardiol 1994;73:922–923.) for this figure. Jhbuk (talk) 20:13, 4 December 2009 (UTC)

No, those statistics and citations apply very narrowly to dissection with retrograde extension to the aortic root. That's a small subset of dissection in general, which is directly addressed in the citation I provided above. -- Scray (talk) 21:36, 4 December 2009 (UTC)

I know, I realised that when I put it up and I removed it from the article. I think the problem here lies in finding out quite how rare SCAD is, as I have read some different information about it. Jhbuk (talk) 22:55, 4 December 2009 (UTC)

Merge coronary artery aneurysm

<oops> Sorry discussion for possible merger goes on target page: Talk:Coronary artery aneurysm#Merge from Coronary artery dissectionDavid Ruben ^Talk 08:57, 4 November 2009 (UTC)

SCAD in pregnancy

Circulation review doi:10.1161/CIRCULATIONAHA.114.011422 JFW | T@lk 17:05, 19 November 2014 (UTC)

Mortality rate

The first paragraph of this article states that "[e]arly studies of the disease placed mortality rates at around 70% but more recent data indicate this figure may be closer to 18%."

A more recent paper from 2006 (PMID 17012132) states that the mortality rate for SCAD ranges from 48-82%. Unfortunately it is paywalled (and the previous information is not available in the abstract).

A more fundamental problem is that the part I've quoted from the article is not actually supported by the cited 1989 paper. From the abstract: "The prognosis of patients surviving the initial event is good, with an 82% survival rate (follow-up: range 1.5 to 144 months, mean 38)". As you can see, the 18% figure is derived by calculating the 'non-survival' rate. However this figure, as you can see, is the survival rate for those who survive the initial incident, not the 'all-in' mortality rate. The abstract also mentions that of the 83 cases examined the diagnosis of SCAD occurred postmortem in 62 of these.

On the above basis I'm going to remove the reference to the 18% figure as it is simply incorrect. Not sure what Wikipedia's policy is on citing information behind journal paywalls so will leave the rest up to someone more knowledgeable.

Text expansion and images - VUSM WikiMed workplan

I'd appreciate your thoughts on the proposed article edits below.

While concise, neutral, and well-sourced from mostly review articles and meta-analyses, this page would benefit from expanding certain text to clarify the topic for a non-medical audience. I'd also recommend adding images to describe the pathology. I would be making these edits over the next couple weeks.

• Insert in-text link back to main dissection page

• Insert image of SCAD (diagram and/or IVUS/OCT images)

• Expand the level of clinical detail for a more general audience, modeled on the Aortic Dissection article

• Several sections are only 1-3 sentences long. Expand these as appropriate to provide more detail and clarify wording for a general audience

• Expand the intro text to a concise overview of disease presentation, diagnosis, and treatment

• Include other clinical images as appropriate (histopathology, etc.)

• I'd like to consider generalizing the page to coronary artery dissection to include spontaneous as well as iatrogenic dissection (see Aortic Dissection article)

○ In the meantime, I would like to include a subsection on iatrogenic dissection to address pathophysiology, prognosis, treatment, and epidemiology of this subtype of coronary dissection

• Typo/grammar correction

Vumedgr (talk) 23:01, 31 October 2019 (UTC) - I'm a fourth year medical student currently in a WikiMed course — Preceding unsigned comment added by Vumedgr (talk • contribs) 21:51, 1 November 2019 (UTC)

Peer review

Lead

The Lead section is easy to read (including for the non-medical reader). I think the first sentence could do a little bit of a better job describing the condition - perhaps you could switch the first and second sentences? The section successfully describes the condition in a concise manner. One small point - the introductory sentence says 80% of cases are in women but the signs/symptoms paragraph says it's 90%.

Content

The causes section is particularly well-written and easy to read. The pathophysiology section is more complex (as is expected given the disease), but maybe could be broken up a little more and explained in lay terms in between the medical terminology. The diagnosis and management sections are excellent - they are thorough, up to date, and easy to read. It would be nice to have the epidemiology as prevalence in the overall population (and again, the percentage of women patients here is 80% - just for consistency sake I would double check that!). I would also include something about the overall mortality rate in the prognosis section.

Tone and Balance

The tone is neutral throughout and does not seem to have any particular bias. In terms of balance of information, I would probably try to bulk up the pathophysiology section a little more to make it slightly more clear what actually is going on in SCAD.

Sources and References

A couple of the references are incomplete and just list the website URL - these are easy to edit if you just click on them and enter the page information! Otherwise, the references are diverse and extremely recent (many from 2019 which is awesome). The majority of articles I clicked on were open-access review articles, which is great.

Organization

Overall, the article is well-written, well-organized, and easy to read. The sections all make sense organizationally and provide a good flow to the article. One small grammatical thing - I would put the citations after the periods at the end of sentences.

Images and Media

It would be awesome to have an image of coronary artery dissection!

Overall impressions

Overall, I think this is a great article. I think you've added a lot of important content. The diagnosis section is particularly impressive and looking back at old versions, you've done a lot of work to this segment! I think you've also made the article a lot easier to read as well, which is a difficult task given the complexity of the disease and pathophysiology. Great job!!

Stephhads (talk) 15:58, 14 November 2019 (UTC)

Peer Review Response

Thanks for the input, Stephhads. Based on your suggestions I made the following edits:

• Edited the Lead for readability and addressed the 80/90% inconsistency
• Explained how SCAD leads to MI in more detail for a lay audience. Unfortunately not much is known about how SCAD develops in the first place so I did not elaborate that.
• I included epidemiology per number of ACS cases in the Epi section. I could not find a great resource for lifetime prevalence of SCAD in the general population
• Included mortality rate and rate of recurrence
• Fixed references
• Added a diagram of SCAD