Article Text

Original research
Clinical outcomes in spontaneous coronary artery dissection
  1. Marcos Garcia-Guimaraes1,2,
  2. Monica Masotti3,
  3. Ricardo Sanz-Ruiz4,5,6,
  4. Fernando Macaya7,8,
  5. Gerard Roura9,
  6. Juan Manuel Nogales10,
  7. Helena Tizón-Marcos1,2,
  8. Maite Velázquez-Martin6,11,12,
  9. Gabriela Veiga13,
  10. Xacobe Flores-Ríos14,
  11. Omar Abdul-Jawad Altisent3,15,
  12. Marcelo Jimenez-Kockar16,
  13. Santiago Camacho-Freire17,
  14. Jose Moreu18,
  15. Soledad Ojeda19,20,
  16. Sandra Santos-Martinez6,21,
  17. Ancor Sanz-Garcia22,
  18. David del Val23,24,
  19. Teresa Bastante23,24,
  20. Fernando Alfonso23,24
  21. on behalf of the Spanish Registry on SCAD investigators
  1. 1 Department of Cardiology, Hospital del Mar, Barcelona, Spain
  2. 2 Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
  3. 3 Department of Cardiology, Hospital Clínic, Barcelona, Spain
  4. 4 Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  5. 5 Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
  6. 6 Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
  7. 7 Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
  8. 8 Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
  9. 9 Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
  10. 10 Department of Cardiology, Hospital Universitario de Badajoz, Badajoz, Spain
  11. 11 Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
  12. 12 Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
  13. 13 Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
  14. 14 Department of Cardiology, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
  15. 15 Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  16. 16 Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  17. 17 Department of Cardiology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
  18. 18 Department of Cardiology, Hospital General Universitario de Toledo, Toledo, Spain
  19. 19 Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain
  20. 20 Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
  21. 21 Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
  22. 22 Data Analysis Unit, Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
  23. 23 Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
  24. 24 Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
  1. Correspondence to Dr Fernando Alfonso; falf{at}hotmail.com

Abstract

Objective Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome. Our aim was to assess adverse events at follow-up from a nationwide prospective cohort.

Methods The Spanish Registry on SCAD (SR-SCAD) included patients from 34 hospitals. All coronary angiograms were analysed by two experts. Those cases with doubts regarding the diagnosis of SCAD were excluded. The angiographic SCAD classification by Saw et al was followed. Major adverse cardiovascular and cerebrovascular event (MACCE) was predefined as composite of death, myocardial infarction, unplanned revascularisation, SCAD recurrence or stroke. All events were assigned by a Clinical Events Committee.

Results After corelab evaluation, 389 patients were included. Most patients were women (88%); median age 53 years (IQR 47–60). Most patients presented as non-ST-segment-elevation myocardial infarction (54%). A type 2 intramural haematoma (IMH) was the most frequent angiographic pattern (61%). A conservative initial management was selected in 78% of patients. At a median time of follow-up of 29 months (IQR 17–38), 46 patients (13%) presented MACCE, mainly driven by reinfarctions (7.6%) and unplanned revascularisations (6.2%). Previous history of hypothyroidism (HR 3.79; p<0.001), proximal vessel involvement (HR 2.69; p=0.009), type 2 IMH (HR 2.12; p=0.037) and dual antiplatelet therapy (DAPT) at discharge (HR 2.18; p=0.042) were independent predictors of MACCE.

Conclusions In this large prospective cohort of patients with SCAD, prognosis was overall favourable, with events mainly driven by reinfarctions or unplanned revascularisations. History of hypothyroidism, proximal vessel involvement, type 2 IMH and DAPT at discharge were associated with MACCE.

Trial registration number NCT03607981.

  • acute coronary syndrome
  • myocardial infarction
  • coronary stenosis

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @Guimacardio, @RiSanz2020, @macayaten, @helenatmCARDIO, @gveigafernandez, @xacobeflores, @CamachoFreire, @OjedaOjeda18, @drassantos, @teresabastante

  • Contributors MG-G is responsible for the overall content as the guarantor. MG-G extracted the data, performed the statistical analyses and drafted the manuscript. TB, FA and AS interpreted the results. All other authors participated in data collection and provided a critical review of the manuscript.

  • Funding This study was partially funded through a Rio Hortega grant by the Carlos III Health Institute assigned to Marcos García-Guimaraes (CM17 / 00267).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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