Abstract 16100: Predictors of Mortality in Patients With Spontaneous Coronary Artery Dissection: National Inpatient Sample 2009-2010
Background: Spontaneous coronary artery dissection (SCAD) is a rare and challenging clinical entity. The pathophysiology remains poorly understood and little is known about the factors predicting mortality.
Hypothesis: We aimed to study the epidemiology of SCAD and predictors of mortality in patients with SCAD.
Methods: All patients diagnosed with SCAD in the Nationwide Inpatient Sample 2009 - 2010 database using International Classification of Diseases 414.12 were included in the analysis. Chronic conditions included in the analysis were diabetes, hypertension, dyslipidemia, smoking, heart failure, ventricular arrhythmias, alcohol use, anxiety and hyperthyroidism. Non-cardiovascular risk factors were fibromuscular dysplasia, connective tissue disorders, Ehlers-Danlos syndrome, Marfan’s syndrome, sarcoidosis, crohn’s disease, and early or premature labor.
Results: The prevalence of SCAD was 0.02% (n = 11,255) out of all in-hospital admissions in United States. The mean age was 63.25 years with women (64.62) years being older than men (62.25 years) (p < 0.0019). In-hospital mortality rate was 4.2%, with women (5.5%) having higher mortality than men (3.2%) (p = 0.009). Interestingly, ventricular arrhythmias (OR 5.86, p=0.001), hyperlipidemia (OR 0.26, p=0.001) and CAD (OR 0.31, p=0.001) predicted mortality in multivariate regression adjusted for demographic factors, traditional cardiovascular risk factors, and other non-cardiovascular conditions.
Conclusion: Our study demonstrated that among patients diagnosed with SCAD, presence of ventricular arrhythmias were associated with increased mortality. Interestingly dyslipidemia and CAD demonstrated reduced mortality, which may represent a different pathophysiological process in this sub group and merits more investigation.
- © 2013 by American Heart Association, Inc.