title: Spontaneous coronary artery dissection: prevalence of predisposing conditions including fibromuscular dysplasia in a tertiary center cohort.
abstract: OBJECTIVE
  We sought to evaluate the prevalence of fibromuscular dysplasia (FMD) and other predisposing conditions among spontaneous coronary artery dissection (SCAD) patients.
  
  
  BACKGROUND
  Spontaneous coronary artery dissection is considered rare. However, we observed many young women with SCAD and concomitant FMD.
  
  
  METHODS
  Spontaneous coronary artery dissection patients were identified prospectively and retrospectively at Vancouver General Hospital over the past 6 years. Coronary angiograms were meticulously reviewed by 2 senior interventional cardiologists. Identified patients were contacted for prospective evaluation at our SCAD clinic, and screening for FMD of renal, iliac, and cerebrovascular arteries was performed with computed tomography angiography or magnetic resonance angiography, if not already screened during the index angiogram. Potential predisposing and precipitating conditions for SCAD were extracted from clinical history.
  
  
  RESULTS
  We identified 50 patients with nonatherosclerotic SCAD from April 2006 to March 2012. Average age was 51.0 years, and almost all were women (98.0%). All presented with myocardial infarction (MI), 30.0% had ST-segment elevation, and 70.0% had non-ST-segment elevation MI. Only 1 was postpartum, and 2 were involved in intense isometric exercises. Emotional stress was reported in 26.0% before the MI. Twelve percent had >1 dissected coronary artery. Most SCAD patients had FMD of ≥1 noncoronary territory (86.0%): 25 of 43 (58.1%) renal, 21 of 43 (48.8%) iliac, and 20 of 43 (46.5%) cerebrovascular (6 of 43, 14.0% had intracranial aneurysm). Five had incomplete FMD screening.
  
  
  CONCLUSIONS
  Nonatherosclerotic SCAD predominantly affects women, and most have concomitant FMD. We suspect these patients have underlying coronary FMD that predisposed them to SCAD, but this requires proof from histology or intracoronary imaging of the affected coronary arteries.
authors.affiliation: University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada. jsaw@mail.ubc.ca
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Saw
authors.forename: Donald
authors.initials: D
authors.lastname: Ricci
authors.forename: Andrew
authors.initials: A
authors.lastname: Starovoytov
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fox
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Buller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000453:epidemiology*; D001955:British Columbia / Q000453:epidemiology; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology*; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D005352:Fibromuscular Dysplasia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006769:Hospitals, General; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed