Prevalence of Extracoronary Arterial Abnormalities in SCAD

Quick Takes

  • Nearly one-in-three patients with spontaneous coronary artery dissection (SCAD) had evidence of concurrent fibromuscular dysplasia (FMD).
  • Rates of severe FMD, arterial dissection, or aneurysm were rare among patients with SCAD.
  • During 5 years of follow-up, extracranial vascular events were rare among patients with SCAD.

Study Questions:

What is the prevalence and severity of fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities in patients with spontaneous coronary artery dissection (SCAD)?

Methods:

The authors conducted a case series of 173 patients in the United Kingdom with angiographically confirmed SCAD between 2015–2019. Imaging of extracoronary beds was performed by magnetic resonance angiography (MRA). Imaging occurred on average 1 year after index SCAD event (median 1 year, interquartile range 1-3 years). Healthy controls (n = 41) were recruited for blinded imaging interpretation. The primary outcome was the diagnosis of FMD, arterial dissection, and aneurysm. Arterial tortuosity was defined both qualitatively (presence or absences of an “S” curve) and quantitatively (number of curves 45%, tortuosity index).

Results:

Of the 173 patients with SCAD, 167 (96.5%) were women and mean age 44.5 years (standard deviation 7.9 years). FMD was identified in 55 patients (31.8%), of whom 16 (29.1%) had involvement of multiple vascular beds. Extracoronary aneurysms were found in 13 patients (7.5%) and dissections were found in three patients (1.7%). Arterial tortuosity findings were similar between patients with SCAD and normal controls. Among the 43 patients who underwent both computed tomographic angiography (CTA) and MRA, the identification of clinically significant arteriopathy was similar. Over a 5-year median follow-up, there were two non–cardiovascular-associated deaths and 35 recurrent myocardial infarctions. There were no primary extracoronary vascular events during follow-up.

Conclusions:

The authors concluded that patients with SCAD have an infrequent burden of severe multivessel FMD, aneurysm, and dissection.

Perspective:

This small, but thorough, study of patients with SCAD confirms the strong association between SCAD and FMD (approximately one-in-three). However, a much smaller proportion of patients had multivessel FMD, aneurysm, or dissection and there were no extracoronary vascular events during a median of 5-year follow-up. Clinicians who care for patients with SCAD should be aware of the strong association between SCAD and FMD. These patients should undergo a one-time head-to-pelvis imaging study (either CTA or MRA) to identify any vascular abnormalities that require follow-up or intervention.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Vascular Medicine, Cardiac Surgery and Arrhythmias, Interventions and ACS, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: Aneurysm, Angiography, Acute Coronary Syndrome, Cardiac Surgical Procedures, Computed Tomography Angiography, Diagnostic Imaging, Dissection, Fibromuscular Dysplasia, Magnetic Resonance Angiography, Myocardial Infarction, Secondary Prevention, Vascular Malformations


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