Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a "conservative" therapeutic strategy

• Published in: JACC. Cardiovascular interventions 2012-10, Vol.5 (10), p.1062-1070
• Main Authors: Alfonso, Fernando, Paulo, Manuel, Lennie, Vera, Dutary, Jaime, Bernardo, Esther, Jiménez-Quevedo, Pilar, Gonzalo, Nieves, Escaned, Javier, Bañuelos, Camino, Pérez-Vizcayno, María J, Hernández, Rosana, Macaya, Carlos
• Format: Article
• Language: English
• Subjects: Aneurysm, Dissecting - drug therapy; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - therapy; Angioplasty, Balloon, Coronary; Anticoagulants - therapeutic use; Coronary Aneurysm - drug therapy; Coronary Aneurysm - mortality; Coronary Aneurysm - therapy; Coronary Angiography; Coronary Artery Disease - pathology; Coronary Vessels - pathology; Female; Humans; Incidence; Male; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Prospective Studies; Spain; Statistics, Nonparametric; Survival Analysis; Time Factors
• ISSN: 1876-7605
• DOI: 10.1016/j.jcin.2012.06.014

This study sought to assess the long-term clinical outcome of patients with spontaneous coronary artery dissection (SCD) managed with a conservative strategy. SCD is a rare, but challenging, clinical entity. A prospective protocol, including a conservative management strategy, was followed. Revascularization was only considered in cases with ongoing/recurrent ischemia. Inflammatory/immunologic markers were systematically obtained. Forty-five consecutive patients (incidence 0.27%) were studied during a 6-year period. Of these, 27 patients (60%) had "isolated" SCD (I-SCD), and 18 had SCD associated with coronary artery disease (A-SCD). Age was 53 ± 11 years, and 26 patients were female. Most patients presented with an acute myocardial infarction. SCD had a diffuse angiographic pattern (length: 31 ± 23 mm). In 11 patients, the diagnosis was confirmed by intracoronary imaging techniques. Sixteen patients (35%) required revascularization during initial admission. One patient died after surgery, but no additional patient experienced recurrent myocardial infarction. No significant inflammatory/immunologic abnormalities were detected. At follow-up (median 730 days), only 3 patients presented with adverse events (1 died of congestive heart failure, and 2 required revascularization). No patient experienced a myocardial infarction or died suddenly. Event-free survival was similar (94% and 88%, respectively) in patients with I-SCD and A-SCD. Notably, at angiographic follow-up, spontaneous "disappearance" of the SCD image was found in 7 of 13 (54%) patients. In this large prospective series of consecutive patients with SCD, a "conservative" therapeutic strategy provided excellent long-term prognosis. Clinical outcome was similar in patients with I-SCD and A-SCD. The natural history of SCD includes spontaneous healing with complete resolution.