Spontaneous coronary artery dissection in old patients: clinical features, angiographic findings, management and outcome

Eur Heart J Acute Cardiovasc Care. 2021 Oct 27;10(8):926-932. doi: 10.1093/ehjacc/zuaa029.


Aims: Spontaneous coronary artery dissection (SCAD) is a relatively rare but well-known cause of acute coronary syndrome. Clinical features, angiographic findings, management and outcomes of SCAD in old patients (>65 years of age) remain unknown.

Methods and results: The Spanish multicentre prospective SCAD registry (NCT03607981), included 318 consecutive patients with SCAD. Data were collected between June 2015 and April 2019. All angiograms were analysed in a centralized corelab. For the purposes of this study, patients were classified according to age in two groups <65 and ≥65 years old and in-hospital outcomes were analysed. Fifty-five patients (17%) were ≥65 years old (95% women). Older patients had more often hypertension (76% vs. 29%, P < 0.01) and dyslipidaemia (56% vs. 30%, P < 0.01), and less previous (4% vs. 18%, P < 0.001) or current smoking habit (4% vs. 33%, P < 0.001). An identifiable trigger was less often present in old patients (27% vs. 43%, P = 0.028). They also had more often severe coronary tortuosity (36% vs. 11%, P = 0.036) and showed more frequently coronary ectasia (24% vs. 9%, P < 0.01). Older patients were more often managed conservatively (89% vs. 75%, P = 0.025), with no significant differences in major adverse cardiac events during index admission (7% vs. 8%, P = 0.858). There were no differences between groups in terms of in-hospital stay, new acute myocardial infarction, unplanned coronary angiography or heart failure.

Conclusion: Older patients with SCAD show different clinical and angiographic characteristics compared with younger patients. Initial treatment strategy was different between groups, though in-hospital outcomes do not significantly differ (NCT03607981).

Keywords: Acute coronary syndrome; Myocardial infarction; Older patients; Spontaneous coronary artery dissection.

MeSH terms

  • Aged
  • Coronary Angiography
  • Coronary Vessel Anomalies* / diagnostic imaging
  • Coronary Vessel Anomalies* / epidemiology
  • Coronary Vessels
  • Dissection
  • Female
  • Humans
  • Hypertension*
  • Male
  • Prospective Studies
  • Risk Factors
  • Vascular Diseases* / diagnosis
  • Vascular Diseases* / epidemiology
  • Vascular Diseases* / therapy

Associated data

  • ClinicalTrials.gov/NCT03607981