Clinical Presentation and Outcome of Patients with Spontaneous Coronary Artery Dissection Versus Atherosclerotic Coronary Plaque Dissection
Background: Atherosclerotic coronary plaque dissection (ACPD) is one cause of acute coronary syndrome caused by underlying atherosclerosis. Spontaneous coronary artery dissection (SCAD) occurs outside the setting of atherosclerosis among young women and individuals with few or no conventional atherosclerotic risk factors, and has emerged as an important cause of acute coronary syndrome, and sudden death. A comparison between ACPD and SCAD has not been previously addressed in the literature. Our study will compare ACPD and SCAD.
Methods: Patients with confirmed diagnosis of SCAD and ACPD were retrospectively identified from 30 centers in 4 Arab Gulf countries between January 2011 and December 2017. In-hospital (VT/VF, MI, PCI, dissection extension, cardiogenic shock, death, ICD placement) and follow-up (MI, de-novo SCAD, spontaneous superior mesenteric artery dissection, death) events were compared between them.
Results: 83 cases of SCAD and 48 ACPD were compared. ACPD patients were more frequently male (91.67% vs 49.40%, p<0.001) and older (58.5 vs 44, p<0.001). Cardiovascular risk factors were more prevalent in patients with ACPD, including diabetes mellitus (60.4% vs. 25.3%), dyslipidemia (62.5% vs. 38.5%), and hypertension (62.5% vs 31.3%), P<0.001. Hospital presentation of ST-elevation myocardial infarction was diagnosed in 48% of SCAD versus 27% of ACPD patients (p = 0.012). SCAD patients received medical-only treatment in 40% of cases and ACPD in 21% (p = 0.042). In-hospital and follow-up events were comparable in both groups (p = 0.25).
Conclusions: Despite a completely different pathophysiology of ACS between SCAD and ACPD, in-hospital and follow-up events were comparable.
Daoulah A, Al-Faifi SM, Madan M, Arafat AA, Hersi AS, Alasmari A, Clarkson FA, Ball V, Alkhushail A, Khan AS, Asrar FM, Haq E, Alama MN, Faden MS, Lotfi A; G-SCAD investigators¶. Clinical Presentation and Outcome of Patients with Spontaneous Coronary Artery Dissection Versus Atherosclerotic Coronary Plaque Dissection. Crit Pathw Cardiol. 2020 Jul 9. doi: 10.1097/HPC.0000000000000233. Epub ahead of print.