Spontaneous coronary artery dissection natural history, complications and prognosis
Spontaneous Coronary Artery Dissection Microchapters
Synonyms and keywords: SCAD
The natural history of spontaneous coronary artery dissection has not been well characterized. Early reports based on post-mortem examinations after sudden cardiac death suggest a dismal prognosis. However, recent studies demonstrate that the majority of patients survive initial hospitalization and have a favorable prognosis following clinical stabilization. Some of the complications of SCAD include extension of dissection, recurrence of dissection, myocardial stunning, myocardial infarction, congestive heart failure, cardiogenic shock, ventricular arrhythmia, and sudden cardiac death.
Natural History, Complications and Prognosis
- The natural history of spontaneous coronary artery dissection (SCAD) has not been well characterized.
- Early reports based on post-mortem examinations and small case series suggest a dismal prognosis, with sudden cardiac death as the initial presentation in 28% of cases and an in-hospital mortality of 49%.
- In contrast, data from recent studies demonstrate that the majority of SCAD lesions heal spontaneously over time and achieve complete resolution on repeat angiography within one month among stabilized patients who survive initial hospitalization.
- The risk of recurrence has been reported in 10 to 30% of cases with a 3- to 10-year follow-up from different series that adopted a non-revascularization management approach.
- Extension of dissection
- Recurrence of dissection
- Myocardial stunning
- Myocardial infarction
- Congestive heart failure
- Cardiogenic shock
- Ventricular arrhythmia
- Sudden cardiac death
- Iatrogenic catheter-induced coronary artery dissection (prevalence of 3.4%, compared with <0.2% for standard coronary angiography)
- Long-term survival after an index SCAD episode appears to be better compared with that of acute coronary syndrome (ACS).
- The rate of major adverse cardiac events (MACE) is comparable between post-SCAD and post-ACS settings.
- The rates of in-hospital myocardial infarction and long-term MACE were 4.5% and 20%, respectively.
- Unsuccessful percutaneous coronary intervention (PCI) was observed in approximately one-third of cases.
- In-hospital prognosis was better in the conservative treatment group when compared with patients managed with PCI.
- A large cohort with a median follow-up of 3.1 years reported a post-discharge MACE rate of 19.9% (approximately 6 events/100 person-years), with myocardial infarction (16.8%) and recurrent SCAD (10.4%) as the most frequent events.
- Kolle, Patrick T.; Cliffe, Charles M.; Ridley, David J. (1998). "Immunosuppressive therapy for peripartum-type spontaneous coronary artery dissection: Case report and review". Clinical Cardiology. 21 (1): 40–46. doi:10.1002/clc.4960210108. ISSN 0160-9289.
- Saw, J.; Aymong, E.; Sedlak, T.; Buller, C. E.; Starovoytov, A.; Ricci, D.; Robinson, S.; Vuurmans, T.; Gao, M.; Humphries, K.; Mancini, G. B. J. (2014). "Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes". Circulation: Cardiovascular Interventions. 7 (5): 645–655. doi:10.1161/CIRCINTERVENTIONS.114.001760. ISSN 1941-7640.
- Rogowski, Sebastian; Maeder, Micha T.; Weilenmann, Daniel; Haager, Philipp K.; Ammann, Peter; Rohner, Franziska; Joerg, Lucas; Rickli, Hans (2017). "Spontaneous Coronary Artery Dissection". Catheterization and Cardiovascular Interventions. 89 (1): 59–68. doi:10.1002/ccd.26383. ISSN 1522-1946.
- Tweet, M. S.; Hayes, S. N.; Pitta, S. R.; Simari, R. D.; Lerman, A.; Lennon, R. J.; Gersh, B. J.; Khambatta, S.; Best, P. J. M.; Rihal, C. S.; Gulati, R. (2012). "Clinical Features, Management, and Prognosis of Spontaneous Coronary Artery Dissection". Circulation. 126 (5): 579–588. doi:10.1161/CIRCULATIONAHA.112.105718. ISSN 0009-7322.
- Tweet, M. S.; Eleid, M. F.; Best, P. J. M.; Lennon, R. J.; Lerman, A.; Rihal, C. S.; Holmes, D. R.; Hayes, S. N.; Gulati, R. (2014). "Spontaneous Coronary Artery Dissection: Revascularization Versus Conservative Therapy". Circulation: Cardiovascular Interventions. 7 (6): 777–786. doi:10.1161/CIRCINTERVENTIONS.114.001659. ISSN 1941-7640.
- Nakashima, Takahiro; Noguchi, Teruo; Haruta, Seiichi; Yamamoto, Yusuke; Oshima, Shuichi; Nakao, Koichi; Taniguchi, Yasuyo; Yamaguchi, Junichi; Tsuchihashi, Kazufumi; Seki, Atsushi; Kawasaki, Tomohiro; Uchida, Tatsuro; Omura, Nobuhiro; Kikuchi, Migaku; Kimura, Kazuo; Ogawa, Hisao; Miyazaki, Shunichi; Yasuda, Satoshi (2016). "Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris–Myocardial Infarction Multicenter Investigators in Japan". International Journal of Cardiology. 207: 341–348. doi:10.1016/j.ijcard.2016.01.188. ISSN 0167-5273.
- Saw, Jacqueline; Humphries, Karin; Aymong, Eve; Sedlak, Tara; Prakash, Roshan; Starovoytov, Andrew; Mancini, G.B. John (2017). "Spontaneous Coronary Artery Dissection". Journal of the American College of Cardiology. 70 (9): 1148–1158. doi:10.1016/j.jacc.2017.06.053. ISSN 0735-1097.
- Prakash, Roshan; Starovoytov, Andrew; Heydari, Milad; Mancini, G.B. John; Saw, Jacqueline (2016). "Catheter-Induced Iatrogenic Coronary Artery Dissection in Patients With Spontaneous Coronary Artery Dissection". JACC: Cardiovascular Interventions. 9 (17): 1851–1853. doi:10.1016/j.jcin.2016.06.026. ISSN 1936-8798.
- Hany Awadalla, Sameh Sabet, Ashraf El Sebaie, Oscar Rosales & Richard Smalling (2005). "Catheter-induced left main dissection incidence, predisposition and therapeutic strategies experience from two sides of the hemisphere". The Journal of invasive cardiology. 17 (4): 233–236. PMID 15831980. Unknown parameter
- Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D; et al. (2014). "Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes". Circ Cardiovasc Interv. 7 (5): 645–55. doi:10.1161/CIRCINTERVENTIONS.114.001760. PMID 25294399.
- Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS; et al. (2014). "Spontaneous coronary artery dissection: revascularization versus conservative therapy". Circ Cardiovasc Interv. 7 (6): 777–86. doi:10.1161/CIRCINTERVENTIONS.114.001659. PMID 25406203.
- Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ; et al. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.