Characterization of single vs. recurrent spontaneous coronary artery dissection

Abstract

Background Spontaneous coronary artery dissection is a rare non-atherosclerotic cause of acute coronary syndromes, often underdiagnosed based on standard coronary angiography. Moreover, features, presentation, and intravascular imaging of recurrent spontaneous dissections have not been assessed. Methods Patients with recurrent spontaneous coronary artery dissection, who were admitted to our catheterization laboratory over a 10-year period, were identified. Demographic, clinical, angiographic, and intravascular imaging data were reviewed and analyzed, comparing patients with a single event with those who had a recurrence. Results Over the study period, 31 (0.2%, mean age 48.1 ± 8.8 years, 24 females) of 10,954 patients who underwent coronary angiography experienced a single spontaneous coronary artery dissection, and 6 (0.05%, mean age 49.3 ± 10.1 years, 4 females) experienced recurrent spontaneous coronary artery dissection. No patient suffered more than 2 dissections. Arterial hypertension ( p = 0.004), a string sign measuring >15 mm on angiography, and hematoma on intravascular ultrasound imaging were more frequently observed in patients with recurrent spontaneous coronary artery dissection. Conclusions Hypertension, length of the string sign on angiography, and hematoma on intravascular ultrasound imaging might identify patients at higher risk of recurrent spontaneous coronary artery dissection despite a lifelong dual antiplatelet regimen.

Factors associated with recurrent spontaneous coronary artery dissection: a systematic review and meta-analysis

“…A total of 14 cohort studies comprising 4206 patients with SCAD were included [4,7,[11][12][13][14][15][16][17][18][19][20][21][22]. Results of quality assessment are shown in Table S3 (Supplemental Digital Content 1; http://links.lww.com/MCA/A500).…”

Systematic review and meta-analysis of the incidence of recurrence of spontaneous coronary artery dissection

“…There were no randomised controlled trials available for inclusion. The study design for all 19 studies was observational [2,4,5,7,9–23]. The sample size ranged from 10 to 327 participants.…”

“…The study design for all 19 studies was observational [2,4,5,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The sample size ranged from 10 to 327 participants.…”

In-hospital recurrent spontaneous coronary artery dissection affecting multiple arteries

“…In this context, coronary angiography remains the standard imaging study for patients presenting with SCAD; 1,2,4 however, due to its two-dimensional luminogram poor accuracy in imaging the entire arterial wall, the diagnosis of SCAD can be underestimated in up to 70% when performed by physicians unfamiliar with the angiographic variants of the disease, and who expect to find only evidence of multiple radiolucent lumens. 2,3,5 Although the conservative approach is the first choice in managing SCAD, the optimal strategy remains undetermined and no randomized controlled trials have compared medical therapies with revascularization strategies. Besides that, in-hospital outcomes are reasonably acceptable with a recurrent infarction rate of approximately 5% to 10%, and a recurrent SCAD rate lower than 15%.…”