Coronary Artery Disease
Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection

https://doi.org/10.1016/j.amjcard.2015.03.039Get rights and content

The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 ± 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis.

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Methods

From 2001 to December 2013, patients with angiographic diagnosis of SCAD admitted to institutions participating in the study were evaluated. Patients were identified using retrospective and prospective methods. Patients were retrospectively identified using a local institutional database that specifically included the term “spontaneous coronary dissection” among the diagnostic variables. From 2010, patients with diagnoses of SCAD were also included in the study. Patients were analyzed as

Results

We identified 134 patients with SCAD. Forty-six patients (34%) were retrospectively identified, and 88 patients (66%) were prospectively identified. Baseline characteristics and clinical presentation are listed in Table 1. The average age was 52 ± 11 years (range 28 to 86), and 109 (81%) were women. Almost all patients (124 of 134 [93%]) were admitted with acute coronary syndromes (ACS). Forty-nine percent of patients presented with STEMI and 40% with non–ST-segment elevation MI. Single-vessel

Discussion

The present observational study reports clinical and procedural features as well as long-term prognosis of 1 of the largest series of patients with SCAD described to date. The main findings of the present study are that the short- and long-term prognosis are generally favorable, procedural success of PCI is lower than expected, and case-specific treatment seems feasible and safe.

In the present registry, in-hospital prognosis was generally favorable, with a mortality rate of approximately 2%,

Disclosures

The authors have no conflicts of interest to disclose.

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