Long-Term Outcomes of Spontaneous Coronary Artery Dissection

Study Questions:

What are long-term clinical outcomes among patients with spontaneous coronary artery dissection (SCAD)?

Methods:

This was a single-center prospective study of 327 patients with SCAD. All patients were followed for a median of 3.1 years. Baseline characteristics were assessed and clinical predictors for long-term outcomes including recurrent SCAD were defined using multivariate analysis.

Results:

A total of 327 patients were enrolled from 2012-2106. Mean age was 52.5 ± 9.6 years and 91% were women (57% were post-menopausal). All patients presented with acute myocardial infarction (MI) (26% ST-segment elevation MI [STEMI], 74% NSTEMI) and approximately 70% reported an emotional or physical stressor. Overall rate of long-term major adverse cardiac events was 19.9% (death 1.2%, recurrent MI 16.8%, cerebrovascular accident/transient ischemic attack 1.2%, revascularization 5.8%). SCAD recurred in 10.4% of patients and the risk was augmented by a history of hypertension and diminished in patients treated with a beta-blocker.

Conclusions:

Recurrent cardiovascular events are common among patients with SCAD. Recurrent SCAD occurs in 10% of patients and use of beta-blockers appears to be protective.

Perspective:

SCAD remains under-recognized and incompletely understood. The current analysis from a sizable cohort of patients sheds light on clinical features and long-term outcomes related to SCAD. This diagnosis continues to affect mainly young women, almost always presents as an acute MI, and is associated with an emotional or physical stressor. More than one half of the patients with SCAD have fibromuscular dysplasia (61%) in another arterial bed. The majority of the patients are managed conservatively with low rates of in-hospital adverse events. Patients with SCAD do have frequent recurrent cardiovascular events including 1 in 10 will have another episode of SCAD. Use of beta-blockers and treatment of uncontrolled hypertension appear to protect against recurrent SCAD and should be considered at the time of discharge.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Cardiac Surgery and CHD & Pediatrics, Congenital Heart Disease, CHD & Pediatrics and Interventions, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Interventions and ACS, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Hypertension, Stress

Keywords: Acute Coronary Syndrome, Adrenergic beta-Antagonists, Coronary Vessel Anomalies, Dissection, Fibromuscular Dysplasia, Hypertension, Ischemic Attack, Transient, Myocardial Infarction, Myocardial Revascularization, Outcome Assessment (Health Care), Postmenopause, Stress, Psychological, Stroke, Women


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