Abstract 4006: Spontaneous Dissections of Coronary Arteries (SCAD) and Acute Coronary Syndromes (ACS). Preliminary Results of the Discovery-ACS: A Multicenter Prospective Registry With A Patients-control Group
Background: Spontaneous coronary artery dissection (SCAD) is an unusual cause of myocardial ischemia and sudden death. We report the preliminary data of the DISCOVERY (DISsection of the COronary arteries: Veneto and Emilia RegistrY)-ACS, a multicenter, prospective study planned to gather information about the real incidence and the angiographic features of SCAD and to compare clinical characteristics of patients (pts) with and without SCAD in ACS.
Methods and Results: From October 2005 to December 2007,42 (33 Female) consecutive pts (mean age 52 ± 11,4) were enrolled. In the female group no association with peripartum status was detect. The clinical presentation was typical chest pain ( 92% of pts), one aborted sudden cardiac death (2,5%) and absence of symptoms ( 5.5%). 38 pts had an ACS ( 64% STEMI and 32% NSTEMI). The diagnosis of SCAD was made by an angiogram plus intravascular ultrasound at the operators discretion. Of the 9 men, 67% had SCAD of LAD; Of the 33 women, 60.6% showed SCAD of LAD; 18.1% had a dissection of RCA and 10 of LCx. 24% of pts presented a synchronous or staged multivessel SCAD. The morphological classification (NHLBY) was: 42.8% type B;16.6% type D, 26.1% type F; 14.2% type C. No correlation was founded between the culprit artery and type of dissection. Therapeutic strategy was PCI for 43.5% of pts, CABG for 2.5% and medical treatment for 53.8% of pts. Ancillary evaluations concerning the presence of simultaneous carotid arteries dissection and the ocular lens luxation where negative in all pts. All Pts with SCAD where discharged alive. In the same 2 years we collect and analyzed a comparable case-control group of young pts with ACS. Comparing the two groups, the SCAD pts group was characterized by a greater prevalence of STEMI and the absence of MACE in the mid-term(10 months ) f.u.
Conclusions: Our series confirms the female prevalence among pts with SCAD. Almost all patients were admitted with an ACS mainly NSTEMI. Almost one-fourth of pts presented a multivessel SCAD. Early outcome was favourable. More than 50% of the pts were successfully treated only with medical therapy. The case-control group showed more frequent MACE in the mid-term follow-up and a higher prevalence of diabetes and NSTEMI.