Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a "conservative" therapeutic strategy

JACC Cardiovasc Interv. 2012 Oct;5(10):1062-70. doi: 10.1016/j.jcin.2012.06.014.

Abstract

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.

MeSH terms

  • Aneurysm, Dissecting / drug therapy*
  • Aneurysm, Dissecting / mortality
  • Aneurysm, Dissecting / therapy
  • Angioplasty, Balloon, Coronary
  • Anticoagulants / therapeutic use
  • Coronary Aneurysm / drug therapy*
  • Coronary Aneurysm / mortality
  • Coronary Aneurysm / therapy
  • Coronary Angiography
  • Coronary Artery Disease / pathology
  • Coronary Vessels / pathology*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prospective Studies
  • Spain
  • Statistics, Nonparametric
  • Survival Analysis
  • Time Factors

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors