Spontaneous Coronary Artery Dissection

• Published in: Catheterization and cardiovascular interventions 2017-01, Vol.89 (1), p.59-68
• Main Authors: Rogowski, Sebastian, Maeder, Micha T., Weilenmann, Daniel, Haager, Philipp K., Ammann, Peter, Rohner, Franziska, Joerg, Lucas, Rickli, Hans
• Format: Article
• Language: English
• Subjects: antiplatelet therapy; conservative management; myocardial infarction; percutaneous coronary intervention
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26383

Objective We sought to assess the angiographic and long‐term clinical outcomes in a predominantly medically treated population with spontaneous coronary artery dissection (SCAD). Background There are little data on the angiographic and long‐term outcome in patients with SCAD. Methods We studied 64 patients with SCAD (mean age 53 years, 94% females, three peripartum) with acute coronary syndrome who were treated using coronary bypass grafting (n = 1), percutaneous coronary intervention (n = 7), or medical therapy (n = 56). A repeat angiogram was performed in 40/64 (63%) patients. The median clinical follow‐up was 4.5 years. Results Five (8%) patients had a major cardiac event. One patient with peripartum left main SCAD and cardiogenic shock died during PCI. One patient with conservatively treated SCAD of the posterior descending artery suffered out‐of‐hospital cardiac arrest 16 days after the initial angiogram but survived. Three patients experienced a second SCAD in another vessel 3.7, 4.7, and 7.9 years after the index event while the initial dissection had healed. Thirty medically treated patients underwent a scheduled repeat angiogram showing healing of the dissection in all but one patient. After a median follow‐up of 4.5 (1.8–8.4) years, all 63 patients surviving the index event were alive and free of symptoms suggestive of myocardial ischemia. Conclusions In general, the long‐term outcome of patients with SCAD is excellent, and medical therapy can be safely applied in the majority of patients. However, SCAD can be a life‐threatening and sometimes catastrophic event, and some patients experience early or late complications including SCAD of another vessel. © 2015 Wiley Periodicals, Inc.