Clinical Research
Spontaneous Coronary Artery Dissection: Long-Term Follow-Up of a Large Series of Patients Prospectively Managed With a “Conservative” Therapeutic Strategy

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Objectives

This study sought to assess the long-term clinical outcome of patients with spontaneous coronary artery dissection (SCD) managed with a conservative strategy.

Background

SCD is a rare, but challenging, clinical entity.

Methods

A prospective protocol, including a conservative management strategy, was followed. Revascularization was only considered in cases with ongoing/recurrent ischemia. Inflammatory/immunologic markers were systematically obtained.

Results

Forty-five consecutive patients (incidence 0.27%) were studied during a 6-year period. Of these, 27 patients (60%) had “isolated” SCD (I-SCD), and 18 had SCD associated with coronary artery disease (A-SCD). Age was 53 ± 11 years, and 26 patients were female. Most patients presented with an acute myocardial infarction. SCD had a diffuse angiographic pattern (length: 31 ± 23 mm). In 11 patients, the diagnosis was confirmed by intracoronary imaging techniques. Sixteen patients (35%) required revascularization during initial admission. One patient died after surgery, but no additional patient experienced recurrent myocardial infarction. No significant inflammatory/immunologic abnormalities were detected. At follow-up (median 730 days), only 3 patients presented with adverse events (1 died of congestive heart failure, and 2 required revascularization). No patient experienced a myocardial infarction or died suddenly. Event-free survival was similar (94% and 88%, respectively) in patients with I-SCD and A-SCD. Notably, at angiographic follow-up, spontaneous “disappearance” of the SCD image was found in 7 of 13 (54%) patients.

Conclusions

In this large prospective series of consecutive patients with SCD, a “conservative” therapeutic strategy provided excellent long-term prognosis. Clinical outcome was similar in patients with I-SCD and A-SCD. The natural history of SCD includes spontaneous healing with complete resolution.

Key Words

myocardial infarction
optical coherence tomography
revascularization
spontaneous coronary artery dissection
stents

Abbreviations and Acronyms

A-SCD
spontaneous coronary artery dissection associated with coronary artery disease
CAD
coronary artery disease
I-SCD
isolated spontaneous coronary artery dissection
IVUS
intravascular ultrasound
MSCT
multislice computed tomography
NHLBI
National, Heart, Lung, and Blood Institute
OCT
optical coherence tomography
QCA
quantitative coronary angiography
SCD
spontaneous coronary artery dissection
TIMI
Thrombolysis In Myocardial Infarction

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The authors have stated that they have no relationships relevant to the contents of this paper to disclose.