title: Spontaneous Coronary Artery Dissection: Angiographic Follow-Up and Long-Term Clinical Outcome in a Predominantly Medically Treated Population.
abstract: OBJECTIVE
  We sought to assess the angiographic and long-term clinical outcomes in a predominantly medically treated population with spontaneous coronary artery dissection (SCAD).
  
  
  BACKGROUND
  There are little data on the angiographic and long-term outcome in patients with SCAD.
  
  
  METHODS
  We studied 64 patients with SCAD (mean age 53 years, 94% females, three peripartum) with acute coronary syndrome who were treated using coronary bypass grafting (n = 1), percutaneous coronary intervention (n = 7), or medical therapy (n = 56). A repeat angiogram was performed in 40/64 (63%) patients. The median clinical follow-up was 4.5 years.
  
  
  RESULTS
  Five (8%) patients had a major cardiac event. One patient with peripartum left main SCAD and cardiogenic shock died during PCI. One patient with conservatively treated SCAD of the posterior descending artery suffered out-of-hospital cardiac arrest 16 days after the initial angiogram but survived. Three patients experienced a second SCAD in another vessel 3.7, 4.7, and 7.9 years after the index event while the initial dissection had healed. Thirty medically treated patients underwent a scheduled repeat angiogram showing healing of the dissection in all but one patient. After a median follow-up of 4.5 (1.8-8.4) years, all 63 patients surviving the index event were alive and free of symptoms suggestive of myocardial ischemia.
  
  
  CONCLUSIONS
  In general, the long-term outcome of patients with SCAD is excellent, and medical therapy can be safely applied in the majority of patients. However, SCAD can be a life-threatening and sometimes catastrophic event, and some patients experience early or late complications including SCAD of another vessel. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rogowski
authors.affiliation: Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Micha T
authors.initials: MT
authors.lastname: Maeder
authors.affiliation: Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Weilenmann
authors.affiliation: Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Philipp K
authors.initials: PK
authors.lastname: Haager
authors.affiliation: Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Ammann
authors.affiliation: Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Franziska
authors.initials: F
authors.lastname: Rohner
authors.affiliation: Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Lucas
authors.initials: L
authors.lastname: Joerg
authors.affiliation: Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Hans
authors.initials: H
authors.lastname: Rickli
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000328:Adult; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011247:Pregnancy; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications / Q000151:congenital* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy
chemical_list: D002317:Cardiovascular Agents
keywords: antiplatelet therapy; conservative management; myocardial infarction; percutaneous coronary intervention