Clinical characteristics and long-term prognosis of spontaneous coronary artery dissection: A single-center Chinese experience

Abstract

Background and objective: Spontaneous coronary artery dissection (SCD) remains a rare and important cause of coronary artery disease (CAD). The purpose of this study was to describe the clinical and angiographic features in SCD and to evaluate the treatment and long-term prognosis of this condition in China.

Methods: This retrospective cohort study included 118 Chinese patients with SCD confirmed by coronary angiography. Clinical and angiographic features, treatment modalities and outcomes of SCD were estimated.

Results: The overall prevalence of SCD was 0.15%. Age was 57 ± 10 years; 86% patients were men; 75% presented with acute coronary syndrome (ACS); 72% had concomitant atherosclerotic CAD. SCD often affected right coronary artery (RCA) and caused a short dissection (< 20mm). A conservative therapy was used in 28% of patients and revascularization in 72% (percutaneous coronary intervention [PCI] 57%; coronary artery bypass grafting [CABG] 15%). Only one patient died during hospitalization due to multiple organ failure after CABG. During a median follow-up of 43 months (range, 1 - 158 months), 32 patients had a new-onset ACS, 9 received revascularization (7 PCI and 2 CABG), and 8 died. The Kaplan-Meier estimated 12-year rates of freedom from cardiac death and ACS were both higher in revascularization versus conservative therapy (78% versus 57%; P = 0.023; 48% versus 25%, P = 0.014). No significant difference was found in freedom from revascularization between the two therapies.

Conclusions: In China, SCD was usually associated with atherosclerosis and predominantly affected male population. SCD often affected RCA and caused a short dissection. In-hospital mortality rate was low regardless of therapeutic strategy. However, a significantly better long-term prognosis was observed in the revascularization compared with conservative therapy.

Keywords: Acute coronary syndrome; Coronary angiography; Coronary artery bypass grafting; Coronary artery disease; Percutaneous coronary intervention; Spontaneous coronary artery dissection.

Fig.1

Two types of SCD. One is non-atherosclerotic (A) and the other is atherosclerotic (B). White arrows denote the angiographic intimal flap. Black arrows denote atherosclerotic lesions. SCD: Spontaneous coronary artery dissection.

Fig.2

Flow chart showing management and outcomes for patients with SCD. SCD: Spontaneous coronary artery dissection; CABG: Coronary artery bypass surgery; PCI: Percutaneous coronary intervention; STEMI: st-segment elevation myocardial infarction; NSTEMI: Non-st-segment elevation myocardial infarction; UAP: unstable angina pectoris.

Fig.3

Long-term follow-up for SCD patients according to treatment strategy. (A) Freedom from cardiac death (B) Freedom from revascularization (C) Freedom from ACS SCD: Spontaneous coronary artery dissection; ACS: Acute coronary syndrome.