Clinical characteristics and prognosis of patients with spontaneous coronary artery dissection

Objective To analyze the clinical characteristics and prognosis of patients with spontaneous coronary artery dissection (SCAD).

Methods A retrospective analysis was conducted in 40 patients with acute myocardial infarction (AMI). All patients were diagnosed with SCAD during hospitalization through coronary angiography (CAG) or intravascular ultrasound (IVUS). The clinical characteristics, CAG or IVUS findings, and treatment regimens of the patients were analyzed, and their prognosis was assessed through follow-up.

Results Among 40 SCAD patients, there were 11 males and 29 females, with a mean age of (53.04±9.15) years. Twelve patients had identified causative factors, and seven patients presented with chest pain as the initial symptom. CAG or IVUS results showed that a total of 69 SCAD lesions were detected in 40 patients, with 15 patients having a single lesion. The primary treatment approach for the patients was medical therapy. The median follow-up duration was 34 months (ranging 2 to 48 months), during which 5 major adverse cardiovascular and cerebrovascular events (MACCE) occurred. The patients were divided into MACCE group (5 patients) and non-MACCE group (35 patients) based on occurrence of MACCE. The mean age and the incidence of regional wall motion abnormalities on echocardiography were higher in the MACCE group than in the non-MACCE group(P < 0.05).

Conclusion SCAD has distinct imaging features on CAG, and IVUS can confirm the diagnosis. Most patients are treated with medical therapy and have a generally favorable prognosis. However, patients with older age or regional wall motion abnormalities on echocardiography have poorer prognosis.