Spontaneous coronary artery dissection: aggressive vs. conservative therapy.
BACKGROUND
Spontaneous coronary artery dissection (SCAD) is a rare condition that commonly presents as an acute coronary event in the younger population, especially in females of childbearing age. Generally, there is no consensus on the etiology, prognosis, and treatment of SCAD.


METHODS
The Medline database was searched for "spontaneous coronary artery dissection" between 1931 and 2008. A total of 440 cases of SCAD were identified. Demographic data were analyzed with either the Student's t-test or the chi-square test for categorical and nominal variables, respectively. Kaplan-Meier outcome analysis was used to assess the outcome of a given treatment for all patients after 1990.


RESULTS
SCAD was found more commonly in females with 308 (70%) cases. Pregnancy was associated with SCAD in 80 (26.1%) cases. Among pregnant patients, 67 (83.8%) developed SCAD in the postpartum period and 13 (16.2%) patients in the prepartum period. Analysis of treatment modalities showed that 21.2% of the patients who were conservatively managed after the initial diagnosis eventually required surgical or catheter-based intervention compared to 2.5% of patients who were initially treated with an aggressive strategy. Kaplan-Meier analysis showed that patients with an isolated single lesion in left or right coronary artery had a statistically significant better outcome when treated with an early aggressive strategy, including coronary artery bypass grafting (CABG) or stent placement as compared to a conservative strategy (p = 0.023, p = 0.006, respectively).


CONCLUSIONS
Early intervention with either CABG or percutaneous coronary intervention following the diagnosis of SCAD leads to a better outcome and less need for further intervention.
Shamloo
Behrooz K
BK
Department of Internal Medicine, Division of Cardiovascular Diseases, Howard University Hospital, Washington, DC, USA. bzshamloo@gmail.com
Chintala
Rajesh S
RS
Nasur
Ali
A
Ghazvini
Mohammad
M
Shariat
Parastoo
P
Diggs
James A
JA
Singh
Steven N
SN
D000328:Adult; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality / Q000601:surgery / Q000628:therapy; D015607:Stents / Q000706:statistics & numerical data