Abstract 14504: Outcomes After Spontaneous Coronary Artery Dissection: A Long-Term Single Center Experience
Background: Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic acute coronary event of uncertain etiology. Demographics, optimal treatment modalities and outcomes remain poorly understood.
Methods: A retrospective single-center study was performed to identify consecutive patients with angiographically confirmed SCAD between 1979 and 2010. Demographics, treatment modalities, in-hospital and long term outcomes were evaluated.
Results: Seventy patients with SCAD were identified with a mean age of 43.8 + 11.6 years. Fifty-four (77%) were women of whom 11 (20%) were postpartum and 10 (19%) were taking hormonal therapies. Other associated features included connective tissue disorders in 10 (14%) and extreme physical exertion in 12 (17%). There were no etiologic factors in 26 (37%). Clinical presentation was STEMI (50%), NSTEMI (40%) or symptoms without ECG changes (10%). Notably, 10 patients (14%) experienced life-threatening ventricular arrhythmias during initial presentation, and 16 (23%) presented with multivessel SCAD. Initial management strategy was conservative (39%), percutaneous coronary intervention (PCI, 40%), fibrinolysis (19%) and coronary artery bypass grafting (3%). There were no in-hospital deaths in those treated with an initial non-invasive strategy. However, of those who underwent initial PCI, the procedure was technically unsuccessful in 8/28 (29%) with 1 in-hospital death. Long-term follow up (median 44 months, IQR 17, 106) revealed recurrence of SCAD in 10.4%, death in 4.5% and heart failure in 4.9% at 5 years. The 10-year major adverse cardiac event rate (MACE) was 44.9% (death 8.5%, heart failure 11.2%, myocardial infarction 33.5% and SCAD recurrence 26%).
Conclusion: This descriptive single center analysis of the largest SCAD series to date reveals SCAD to affect a young, predominantly female population. Potential risk factors are identifiable in the majority. While in-hospital mortality is low, rates of long-term MACE and SCAD recurrence are notable, underscoring the need for close clinical follow up and additional research.
- Acute coronary syndromes
- Sudden cardiac death
- Myocardial infarction, STEMI
- Ventricular fibrillation
- © 2011 by American Heart Association, Inc.