{
  "abstract": "Background Hypothyroidism has been suggested as a predisposing and prognostic factor in patients with spontaneous coronary artery dissection (SCAD), but evidence in this regard is very limited.Methods This study sought to compare differences in clinical presentation, angiographic findings, management and outcomes between SCAD patients with (H-SCAD) and without (NH-SCAD) a history of hypothyroidism from the prospective nation-wide Spanish SCAD Registry.Results Overall, 47 H-SCAD (12%) and 342 NH-SCAD patients were included. H-SCAD patients when compared with NH-SCAD patients were significantly older (57±10 vs 54±12 years, p=0.045), had more frequent dyslipidaemia (49% vs 31%, p=0.013) and a non-significant trend to more associated fibromuscular dysplasia (47% vs 30%, p=0.191). Clinical presentation did not differ between groups, with non-ST-segment elevation myocardial infarction being the more frequent diagnosis at admission (62% vs 53%, p=0.273). H-SCAD patients showed more frequent multivessel involvement (19% vs 9%, p=0.044), angiographic type 2b lesions (36% vs 23%, p=0.037), lesions at segments with side-branches (68% vs 52%, p=0.026) and tighter lesions (88±13% vs 77±21% diameter stenosis, p=0.001), but less involvement of proximal segments (5% vs 15%, p=0.044). Revascularisation was more commonly needed in H-SCAD patients (34% vs 20%, p<0.05). At late clinical follow-up (median 29 months), the H-SCAD group had a higher adverse event rate (27% vs 11%, p=0.033), mainly driven by myocardial infarction (16% vs 6%, p=0.031) and SCAD recurrence (9% vs 1%, p<0.001). On multivariable analysis, the presence of hypothyroidism remained independently associated with adverse clinical events.Conclusions H-SCAD patients were older and had a more diffuse and aggressive angiographic phenotype, including type 2b lesions, tighter lesions and more frequent multivessel involvement. Revascularisation was more frequently needed in H-SCAD patients. Long-term outcomes were poorer in this group, mainly driven by myocardial infarction and SCAD recurrence.",
  "authors": [
    {
      "affiliations": [
        "Cardiology, Hospital Juan Ramon Jimenez, Huelva, Spain",
        "University of Huelva, Huelva, Spain"
      ],
      "name": "Santiago J Camacho Freire"
    },
    {
      "affiliations": [
        "Department of Cardiology, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain"
      ],
      "name": "Marcos Garcia-Guimaraes"
    },
    {
      "affiliations": [
        "Cardiology, Hospital General Universitario Gregorio Marañón. Instituto de investigación sanitaria Gregorio Marañón (IisGM), Madrid, Spain"
      ],
      "name": "Ricardo Sanz-Ruiz"
    },
    {
      "affiliations": [
        "Cardiology, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain"
      ],
      "name": "Manel Sabaté Tenas"
    },
    {
      "affiliations": [
        "Hospital Clinico Universitario San Carlos, Madrid, Spain"
      ],
      "name": "Fernando Macaya"
    },
    {
      "affiliations": [
        "Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain"
      ],
      "name": "Gerard Roura"
    },
    {
      "affiliations": [
        "Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"
      ],
      "name": "Marcelo Jimenez"
    },
    {
      "affiliations": [
        "Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Madrid, Spain"
      ],
      "name": "David del Val"
    },
    {
      "affiliations": [
        "Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Madrid, Spain"
      ],
      "name": "Teresa Bastante"
    },
    {
      "affiliations": [
        "Cardiology, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain"
      ],
      "name": "Maite Velázquez - Martin"
    },
    {
      "affiliations": [
        "Cardiology, La Paz University Hospital, Madrid, Community of Madrid, Spain"
      ],
      "name": "Santiago Jimenez Valero"
    },
    {
      "affiliations": [
        "Cardiology, Hospital Juan Ramon Jimenez, Huelva, Spain"
      ],
      "name": "Antonio Enrique Gómez-Menchero"
    },
    {
      "affiliations": [
        "Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Madrid, Spain"
      ],
      "name": "Fernando Alfonso"
    }
  ],
  "title": "Hypothyroidism in spontaneous coronary artery dissection: presentation, clinical and angiographic findings, management and outcomes",
  "uid": "5d73bc7f-e787-502a-862c-28e5d7e99779"
}