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. 2019:23:18.278.
doi: 10.7812/TPP/18.278. Epub 2019 Oct 11.

Spontaneous Coronary Artery Dissection: Clinical Characteristics, Management, and Outcomes in a Racially and Ethnically Diverse Community-Based Cohort

Stephanie Chen  1 , Maqdooda Merchant  2 , Kenneth N Mahrer  1 , Robert J Lundstrom  1 , Sahar Naderi  1 , Anne Ch Goh  1
Affiliations

Spontaneous Coronary Artery Dissection: Clinical Characteristics, Management, and Outcomes in a Racially and Ethnically Diverse Community-Based Cohort

Stephanie Chen et al. Perm J. 2019.

Abstract

Context: Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome, which predominantly affects healthy women; however, few data define this vulnerable population.

Objective: To identify demographic and clinical characteristics of patients with SCAD and determine outcomes in a community-based cohort.

Design: Retrospective cohort study of patients with SCAD at Kaiser Permanente Northern California during a 10-year period. We compared 111 SCAD cases with 333 healthy, matched controls.

Main outcome measures: Predisposing factors, treatment modalities, and inhospital and late outcomes.

Results: Patients with SCAD had a mean age (standard deviation) of 48.1 (11) years; 92.8% were women, and 49.5% were nonwhite. Of women, 9% were peripartum. Fibromuscular dysplasia was identified in 21.8% of femoral angiograms obtained. With conditional logistic regression, only pregnancy and hyperlipidemia were associated with SCAD compared with controls. Fifty-five patients (49.5%) were successfully treated without revascularization; of the 54 who had urgent percutaneous coronary intervention, 2 required coronary artery bypass grafting for SCAD extension. During a median follow-up of 2.6 years, major adverse cardiovascular events occurred in 8.1% of patients. Pregnancy-related SCAD was not associated with worsened outcomes. However, Emergency Department visits or hospitalizations because of recurrent chest pain occurred frequently for 54% of patients with SCAD.

Conclusion: The study cohort is comparable to published SCAD cohorts, but notable for a racially and ethnically diverse population. Compared with the controls, only pregnancy and hyperlipidemia were associated with SCAD. For the SCAD cases, major adverse cardiovascular events occurred in 8.1%, and race did not influence outcomes.

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Conflict of interest statement

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Initial treatment of spontaneous coronary artery dissection (SCAD) CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention; SCAD = spontaneous coronary artery dissection.
See this image and copyright information in PMC

References

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MeSH terms

Supplementary concepts