title: Coronary artery tortuosity in spontaneous coronary artery dissection: angiographic characteristics and clinical implications.
abstract: BACKGROUND
  Spontaneous coronary artery dissection (SCAD) is an increasingly recognized nonatherosclerotic cause of acute coronary syndrome. The angiographic characteristics of SCAD are largely undetermined. The goal of this study was to determine the prevalence of coronary tortuosity in SCAD and whether it may be implicated in the disease.
  
  
  RESULTS
  Patients with confirmed SCAD (n=246; 45.3±8.9 years; 96% women) and 313 control patients without SCAD or coronary artery disease who underwent coronary angiography were included in this case-control study. Angiograms were reviewed for coronary tortuosity and assigned a tortuosity score. Tortuosity was common in patients presenting with their first SCAD event (78% versus 17% in controls; P<0.0001; tortuosity score, 4.41±1.73 versus 2.33±1.49 in controls; P<0.0001) despite a low prevalence of hypertension (34%). Recurrent SCAD (n=40) occurred within segments of tortuosity in 80% of cases. Severe tortuosity (≥2 consecutive curvatures ≥180°) was associated with a higher risk of recurrent SCAD (hazard ratio, 3.29; 95% confidence interval, 0.99-8.29; P=0.05). Tortuosity score >5 was associated with a trend toward higher risk of recurrent SCAD (P=0.16). Prespecified angiographic markers of tortuosity including corkscrew appearance and multivessel symmetrical tortuosity were associated with extracoronary vasculopathy including fibromuscular dysplasia (P<0.05 for both).
  
  
  CONCLUSIONS
  Coronary artery tortuosity is highly prevalent in the SCAD population and is associated with recurrent SCAD. Recurrent SCAD most often occurs within segments of tortuosity. Angiographic features of SCAD are associated with extracoronary vasculopathy, including fibromuscular dysplasia. These findings suggest that coronary tortuosity may serve as a marker or potential mechanism for SCAD.
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Mackram F
authors.initials: MF
authors.lastname: Eleid
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Raviteja R
authors.initials: RR
authors.lastname: Guddeti
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Marysia S
authors.initials: MS
authors.lastname: Tweet
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Best
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Terri J
authors.initials: TJ
authors.lastname: Vrtiska
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Megha
authors.initials: M
authors.lastname: Prasad
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Sharonne N
authors.initials: SN
authors.lastname: Hayes
authors.affiliation: From the Division of Cardiovascular Diseases and Department of Internal Medicine (M.F.E., R.R.G., M.S.T., A.L., M.S., P.J.B., M.P., C.S.R., S.N.H., R.G.), and Department of Radiology (T.J.V.), Mayo Clinic College of Medicine, Rochester, MN. Gulati.rajiv@mayo.edu.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gulati
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D015984:Causality; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005352:Fibromuscular Dysplasia / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D014652:Vascular Diseases / Q000150:complications / Q000151:congenital* / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D015415:Biomarkers
keywords: coronary angiography; coronary artery dissection, spontaneous; fibromuscular dysplasia