Abstract 5101: ACS in Patients With and Without Spontaneous Dissections of Coronary Arteries: The Discovery Study
Spontaneous coronary dissection ( SCAD) is an unusual, life threatening cause of acute myocardial ischemia. Over 200 cases of SCAD have been reported in the literature but, most of the available clinical information about SCAD derives from case reports and prospective data are lacking. The purpose of DISCOVERY study (DISsection of COronary Arteries: Veneto and Emilia RegistrY) was to prospectively assess clinical characteristics, treatment and outcome of SCAD pts. w/o spontaneous dissections with comparable pts. and to attempt to assess the role of SCAD in the pathogenesis of Acute Coronary Syndromes (ACS) and to determine whether peculiar clinical characteristics may help in defining a diagnostic pattern for SCAD-ACS. From October ’05 to December ’07, 42 consecutive pts ( mean age 51 yrs) were enrolled in the Cardiology Units of the Veneto and Emilia regions. Only cases of angiographically-proven SCAD of major coronary branches were included. Concomitantly, the first incoming ACS pts following a SCAD pts of comparable age and sex was enrolled. Insodoing, a control group of non-SCAD ACS was obtained. Analysis report data on two groups (ACS and SCAD-ACS) in order to analyze presentation, treatment strategies and outcome. In the SCAD-ACS group, no case was associated with peripartum, nor any showed associated carotid disease or lens subluxation. Baseline characteristics were similar in SCAD and non-SCAD ACS. However, SCAD pts had fewer risk factors (r.f.) for coronary disease (p=0.0016), The LAD coronary artery was more commonly involved. Also, presenting ecg pattern was more frequently ST elevation in SCAD compared to non-SCAD (58% vs 33%). Treatment were significantly different in the 2 groups: 54 % of SCAD population had conservative treatment vs 31% in the control group (p=0.002). In revascularized pts, PCI was by far the preferred treatment option. All pts were discharged alive in both groups. During a 18 month f.u., incidence of MACE was 2.3% in SCAD vs 27% in non-SCAD (p<0.001). Our data show how SCAD-ACS pts have fewer coronary r.f. compared to non-SCAD-ACS of comparable age, are less prone to undergo revascularization and exibit a much better long-term prognosis. Some features of SCAD-ACS traditionally considered in SCAD do not appear to be such in our series.