Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a "conservative" therapeutic strategy.
OBJECTIVE
This study sought to assess the long-term clinical outcome of patients with spontaneous coronary artery dissection (SCD) managed with a conservative strategy.


BACKGROUND
SCD is a rare, but challenging, clinical entity.


METHODS
A prospective protocol, including a conservative management strategy, was followed. Revascularization was only considered in cases with ongoing/recurrent ischemia. Inflammatory/immunologic markers were systematically obtained.


RESULTS
Forty-five consecutive patients (incidence 0.27%) were studied during a 6-year period. Of these, 27 patients (60%) had "isolated" SCD (I-SCD), and 18 had SCD associated with coronary artery disease (A-SCD). Age was 53 ± 11 years, and 26 patients were female. Most patients presented with an acute myocardial infarction. SCD had a diffuse angiographic pattern (length: 31 ± 23 mm). In 11 patients, the diagnosis was confirmed by intracoronary imaging techniques. Sixteen patients (35%) required revascularization during initial admission. One patient died after surgery, but no additional patient experienced recurrent myocardial infarction. No significant inflammatory/immunologic abnormalities were detected. At follow-up (median 730 days), only 3 patients presented with adverse events (1 died of congestive heart failure, and 2 required revascularization). No patient experienced a myocardial infarction or died suddenly. Event-free survival was similar (94% and 88%, respectively) in patients with I-SCD and A-SCD. Notably, at angiographic follow-up, spontaneous "disappearance" of the SCD image was found in 7 of 13 (54%) patients.


CONCLUSIONS
In this large prospective series of consecutive patients with SCD, a "conservative" therapeutic strategy provided excellent long-term prognosis. Clinical outcome was similar in patients with I-SCD and A-SCD. The natural history of SCD includes spontaneous healing with complete resolution.
Interventional Cardiology, Cardiovascular Institute, Clínico San Carlos, University Hospital, IdISSC, Madrid, Spain. falf@hotmail.com
Fernando
F
Alfonso
Manuel
M
Paulo
Vera
V
Lennie
Jaime
J
Dutary
Esther
E
Bernardo
Pilar
P
Jiménez-Quevedo
Nieves
N
Gonzalo
Javier
J
Escaned
Camino
C
Bañuelos
María J
MJ
Pérez-Vizcayno
Rosana
R
Hernández
Carlos
C
Macaya
D000784:Aortic Dissection / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D003323:Coronary Aneurysm / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D013030:Spain; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors