Spontaneous Coronary Artery Dissection Angiographic Follow‐Up and Long‐Term Clinical Outcome in a Predominantly Medically Treated Population

• Published in: Catheterization and cardiovascular interventions Vol. 89; no. 1; pp. 59 - 68
• Main Authors: Rogowski, Sebastian, Maeder, Micha T., Weilenmann, Daniel, Haager, Philipp K., Ammann, Peter, Rohner, Franziska, Joerg, Lucas, Rickli, Hans
• Format: Journal Article
• Language: English
• Published: United States 01.01.2017
• Subjects: Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - etiology; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - therapy; Adult; Cardiovascular Agents - adverse effects; Cardiovascular Agents - therapeutic use; Coronary Angiography; Coronary Artery Bypass; Coronary Vessel Anomalies - complications; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessel Anomalies - mortality; Coronary Vessel Anomalies - therapy; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Out-of-Hospital Cardiac Arrest - etiology; Percutaneous Coronary Intervention; Predictive Value of Tests; Pregnancy; Recurrence; Registries; Risk Assessment; Risk Factors; Shock, Cardiogenic - etiology; Switzerland; Time Factors; Treatment Outcome; Vascular Diseases - complications; Vascular Diseases - congenital; Vascular Diseases - diagnostic imaging; Vascular Diseases - mortality; Vascular Diseases - therapy; percutaneous coronary intervention; antiplatelet therapy; conservative management; myocardial infarction
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26383

We sought to assess the angiographic and long-term clinical outcomes in a predominantly medically treated population with spontaneous coronary artery dissection (SCAD). There are little data on the angiographic and long-term outcome in patients with SCAD. 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. 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. 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.