Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection

Christopher W Jensen; Lillian Kang; Mary E Moya-Mendez; Kristen E Rhodin; Andrew M Vekstein; W Schuyler Jones; Jennifer A Rymer; Brittany A Zwischenberger; Adam R Williams

doi:10.1053/j.semtcvs.2023.05.001

Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection

Semin Thorac Cardiovasc Surg. 2023 Aug 25:S1043-0679(23)00088-6. doi: 10.1053/j.semtcvs.2023.05.001. Online ahead of print.

Authors

Christopher W Jensen¹, Lillian Kang², Mary E Moya-Mendez³, Kristen E Rhodin², Andrew M Vekstein², W Schuyler Jones⁴, Jennifer A Rymer⁴, Brittany A Zwischenberger², Adam R Williams²

Affiliations

¹ Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University School of Medicine. Electronic address: christopher.w.jensen@duke.edu.
² Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University School of Medicine.
³ Duke University School of Medicine, Durham, NC.
⁴ Division of Cardiology, Department of Medicine, Duke University School of Medicine.

PMID: 37633623
PMCID: PMC10894310 (available on 2025-02-25)
DOI: 10.1053/j.semtcvs.2023.05.001

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare but important nonatherosclerotic cause of acute coronary syndrome. Indications for revascularization and long-term outcomes of SCAD remain areas of active investigation. We report our experience with initial management strategy and long-term outcomes in SCAD. We reviewed all patients treated at our institution from 1996-2021 with a SCAD diagnosis. Demographics, comorbidities, clinical presentations, angiography findings, and management strategies were obtained by chart review. The primary outcome was a composite of cardiac death, recurrent/progressive SCAD, subsequent diagnosis of congestive heart failure, or subsequent/repeat revascularization after the initial management. Unadjusted Kaplan-Meier survival analysis was performed. Of 186 patients with a SCAD diagnosis treated at our institution, 149 (80%) were female. Medical management was the initial treatment in 134 (72.0%) patients, percutaneous coronary intervention (PCI) in 43 (23.1%), and coronary artery bypass grafting in 9 (4.8%). Surgery/PCI intervention was associated with younger age (38.8 vs 47.7 years, P = 0.01), ST elevation myocardial infarction on presentation (67.0% vs 34.0%, P < 0.001), lower ejection fraction (45.0% vs 55.0%, P = 0.002), and left anterior descending coronary artery dissection (75.0% vs 51.0%, P = 0.006). Ten-year freedom from our composite outcome was similar between revascularized patients and those managed with medical therapy (P = 0.36). Median follow-up time was 4.5 years. SCAD in the setting of ST elevation myocardial infarction, left anterior descending coronary artery involvement, or decreased cardiac function suggests greater ischemic insult and was associated with initial percutaneous or surgical revascularization. Despite worse disease on initial presentation, long-term outcomes of patients undergoing revascularization are similar to medically managed patients with SCAD.

Keywords: CABG; Myocardial infarction; PCI; SCAD; STEMI; Spontaneous coronary artery dissection.

Abstract

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