Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan

Int J Cardiol. 2016 Mar 15;207:341-8. doi: 10.1016/j.ijcard.2016.01.188. Epub 2016 Jan 14.


Background: We sought to compare the prognosis of patients with spontaneous coronary artery dissection (SCAD) and atherosclerosis as the cause of acute myocardial infarction (AMI), especially in young females.

Methods and results: A total of 20,195 patients with AMI at 20 institutions between 2000 and 2013 were retrospectively studied. Major adverse cardiac event (MACE: cardiac death, AMI or urgent revascularization) was the endpoint. The overall prevalence of SCAD was 0.31% (n=63; female, 94%). SCAD developed following emotional stress in 29% of patients. Revascularization was performed in 56% (35 of 63 patients), and SCAD recurrence developed in the originally involved vessel in 6 of 35 patients with revascularization, compared to none among 28 patients after conservative therapy (p=0.002). We compared the clinical characteristics of young female AMI patients aged ≤50years in the SCAD (n=45) and no-SCAD groups (atherosclerotic AMI, n=55). During a median follow-up of 50months, SCAD recurred in 27% of patients, of which 42% was in the first 30days. Kaplan-Meier analysis showed a significantly higher incidence of MACE in the SCAD group compared to the no-SCAD group (hazard ratio, 6.91; 95% confidence interval, 2.5 to 24.3; p<0.001), although the rate of successful percutaneous coronary intervention for SCAD was as high as 92%.

Conclusions: Young female patients with SCAD represent a high-risk subgroup of patients with AMI and require close follow-up.

Keywords: Acute myocardial infarction; Prognosis; Spontaneous coronary artery dissection; Young woman.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Angina Pectoris / diagnosis*
  • Angina Pectoris / epidemiology*
  • Cohort Studies
  • Coronary Vessel Anomalies / diagnosis*
  • Coronary Vessel Anomalies / epidemiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / epidemiology*
  • Prognosis
  • Research Report
  • Retrospective Studies
  • Vascular Diseases / congenital*
  • Vascular Diseases / diagnosis
  • Vascular Diseases / epidemiology

Supplementary concepts

  • Coronary Artery Dissection, Spontaneous