Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection

Am J Cardiol. 2015 Jul 1;116(1):66-73. doi: 10.1016/j.amjcard.2015.03.039. Epub 2015 Apr 8.


The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 ± 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Coronary Angiography*
  • Coronary Artery Bypass / methods
  • Coronary Vessel Anomalies / diagnostic imaging*
  • Coronary Vessel Anomalies / mortality
  • Coronary Vessel Anomalies / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention* / methods
  • Prognosis
  • Prospective Studies
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome
  • Vascular Diseases / congenital*
  • Vascular Diseases / diagnostic imaging
  • Vascular Diseases / mortality
  • Vascular Diseases / surgery

Supplementary concepts

  • Coronary Artery Dissection, Spontaneous