Spontaneous Coronary Artery Dissection and Its Association With Fibromuscular Dysplasia and Other Vascular Abnormalities

Am J Cardiol. 2020 Jan 1;125(1):34-39. doi: 10.1016/j.amjcard.2019.09.043. Epub 2019 Oct 11.


Fibromuscular dysplasia (FMD) has recently been associated with spontaneous coronary artery dissection (SCAD). We sought to further elucidate the association of FMD with SCAD. We performed a retrospective cohort review of patients with SCAD evaluated at our institution from 2008 to 2019. Baseline characteristics, coronary angiographic data, and screening for FMD were recorded. In patients who completed screening for FMD, variables were compared between patients with FMD and those without. We identified 51 patients with SCAD, all of whom were female, with a mean age of 46.8 years. A quarter of patients underwent percutaneous coronary intervention (PCI) and half of those suffered a complication during PCI. 78% of patients underwent complete screening for FMD, of which 63% were diagnosed with multifocal FMD. Vascular abnormalities other than FMD were found in 70% of screened patients. Patients with FMD were older than those without FMD (50.7 vs 42.6 years, p = 0.006). FMD was more frequently associated with type 2 SCAD (84% vs 47%, p = 0.025), tortuous non-SCAD coronaries (96% vs 53%, p = 0.002), and other vascular abnormalities (84% vs 47%, p = 0.03). In conclusion, the majority of patients within the all-female cohort with SCAD were found to have FMD. Other vascular abnormalities were also common. Patients with FMD were older and were more likely to have type 2 SCAD, tortuous non-SCAD coronary arteries, and other vascular abnormalities.

MeSH terms

  • Adult
  • Computed Tomography Angiography
  • Coronary Angiography / methods*
  • Coronary Vessel Anomalies / diagnosis
  • Coronary Vessel Anomalies / etiology*
  • Coronary Vessel Anomalies / surgery
  • Coronary Vessels / diagnostic imaging*
  • Female
  • Fibromuscular Dysplasia / complications*
  • Fibromuscular Dysplasia / diagnosis
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Percutaneous Coronary Intervention / methods
  • Retrospective Studies
  • Vascular Diseases / congenital*
  • Vascular Diseases / diagnosis
  • Vascular Diseases / etiology
  • Vascular Diseases / surgery
  • Vascular Malformations / diagnosis*

Supplementary concepts

  • Coronary Artery Dissection, Spontaneous