Predisposing risk factors, clinical course, and prognosis of spontaneous coronary
artery dissection (SCAD) remain poorly understood. We reviewed medical records and
coronary angiograms of patients admitted to our institution with the diagnosis of
SCAD from 1999 through 2010. A definite diagnosis of SCAD required the agreement of
2 blinded board-certified interventional cardiologists who reviewed all images separately.
Baseline characteristics of patients (n = 23) included mean age 45 ± 11 years, female
gender in all (100%), history of hypertension in 13 (57%), and postpartum in 7 (30%).
Eleven (48%) had ST-segment elevation on initial electrocardiogram. SCAD involved
the left main in 5 patients (21.7%), left anterior descending coronary artery in 16
(70%), left circumflex coronary artery in 8 (35%), and right coronary artery in 6
(26%). Four patients (17%) underwent coronary stenting and 6 (26%) required urgent
bypass surgery. Comparison between postpartum and nonpostpartum patients revealed
significant differences in mean peak troponin levels: 50 ± 34 ng/ml vs 21 ± 23, p
= 0.04, mean left ventricular ejection fraction: 34 ± 6% vs 49 ± 9, p <0.01, proximal
coronary segment distribution: 6 (86%) vs 3 (19%), p = 0.004, and left anterior descending
coronary artery distribution: 7 (100%) vs 9 (56%), p = 0.04, respectively. Repeat
coronary angiographies were performed in 11 patients (46%) during a mean follow-up
of 39 ± 38 months and 10 (91%) were found to have healed SCAD, including those who
had undergone bypass surgery. In conclusion, our patients with SCAD were characterized
by female gender, absence of coronary risk factors, and a high rate of vascular healing
without residual stenosis. Larger infarct was found in postpartum patients.
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Article Info
Publication History
Published online: March 25, 2011
Accepted:
January 18,
2011
Received in revised form:
January 18,
2011
Received:
November 3,
2010
Identification
Copyright
© 2011 Published by Elsevier Inc. All rights reserved.
