Clinical Features, Management and Prognosis of Spontaneous Coronary Artery Dissection
Background—Spontaneous coronary artery dissection (SCAD) is an acute coronary event of uncertain etiology. Clinical features and prognosis remain insufficiently characterized.
Methods and Results—A retrospective single-center cohort study identified 87 patients with angiographically confirmed SCAD. Incidence, clinical characteristics, treatment modalities, in-hospital outcomes and long-term risk of SCAD recurrence or major adverse cardiac events (MACE) were evaluated. Mean age was 42.6 years and 82% were female. Extreme exertion at SCAD onset was more frequent in males (7/16 vs 2/71, p<0.001) and postpartum status was observed in 13/71(18%) females. Presentation was ST-elevation myocardial infarction (STEMI) in 49%. Multivessel SCAD was found in 23%. Initial conservative management (31/87) and coronary artery bypass grafting (7/87) were associated with an uncomplicated in-hospital course, whereas percutaneous coronary intervention (PCI) was complicated by technical failure in 15/43(35%) and one death. During median follow-up of 47 months [IQR 18,106], SCAD recurred in 15 patients, all female. Estimated ten-year rate of MACE (death, heart failure, myocardial infarction and SCAD recurrence) was 47%. Fibromuscular dysplasia (FMD) of the iliac artery was identified incidentally in 8/16 (50%) femoral angiograms undertaken prior to closure device placement and in the carotid arteries of two others with carotid dissection.
Conclusions—SCAD affects a young, predominantly female population, frequently presenting as STEMI. While in-hospital mortality is low regardless of initial treatment, PCI is associated with high rates of complication. Risks of SCAD recurrence and MACE in the long-term emphasize the need for close follow-up. FMD is a novel association and potentially causative factor.
- acute myocardial infarction
- fibromuscular dysplasia
- percutaneous coronary intervention
- spontaneous coronary artery dissection
- Received March 15, 2012.
- Accepted May 29, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited