Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome,
often occurring in young women. The utility of comprehensive imaging and clinical
significance of detected vascular abnormalities have yet to be determined. We hypothesized
that extracoronary vascular abnormalities (EVAs) are common in SCAD and aimed to study
the prevalence and distribution of these findings. We enrolled 115 patients with confirmed
SCAD who were evaluated at the Mayo Clinic SCAD Clinic from February 2010 to May 2014
and prospectively underwent comprehensive computed tomography angiography imaging
of the neck, chest, abdomen, and pelvis (SCAD computed tomography angiography protocol,
n = 95) or had retrospective review of outside studies (n = 20) including head imaging
(n = 40). Follow-up was determined by last clinical visit or study correspondence
and included review of recurrent SCAD or myocardial infarction, congestive heart failure,
and death. We reported EVAs in 66% of patients with SCAD, most frequently in the abdomen
(36%), pelvis (28%), and neck (27%). Only 1 patient had EVA in the chest (aortic dissection
and Marfan's). Fibromuscular dysplasia (FMD) (exclusively multifocal) was the most
common type of EVA (45%). Vascular abnormalities in those with head imaging included
intracranial aneurysms (n = 9) and FMD (n = 3). There were no deaths at median follow-up
of 21 months (Q1 to Q3 7.7 to 55). The presence of FMD was not associated with SCAD
recurrence (relative risk [RR] 1.2; confidence interval [95% CI] 0.60, 2.5), congestive
heart failure (RR 0.66; 95% CI 0.20, 2.3), or myocardial infarction (RR 1.34; 95%
CI 0.69, 2.6). In conclusion, EVAs including FMD, dissections, aneurysms, and dilation
are common in patients with SCAD and occur in a wide anatomic distribution. The presence
of EVAs and/or FMD did not correlate with the risk of subsequent clinical events,
but future studies with increased power and longer follow-up will be important to
further assess the role of EVAs in patients with SCAD.
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Article Info
Publication History
Published online: March 24, 2015
Accepted:
March 10,
2015
Received in revised form:
March 10,
2015
Received:
November 15,
2014
Footnotes
Drs. Prasad and Tweet are first authors.
See page 1676 for disclosure information.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
