AIMS OF THE STUDY
Spontaneous coronary artery dissection (SCAD) is an increasingly
diagnosed cause of acute myocardial infarction. However, there is
still a limited number of larger cohorts with long-term follow-up.
We report on the largest Swiss single-centre cohort to date, with
follow-up of up to 22 years.
We prospectively collected SCAD cases from June 1998 until December
2020. A strategy of systematic follow-up angiography was applied.
Information on long-term follow-up was collected up to the end of
2020. Major cardiovascular events (MACE) were defined as all-cause
death, non-fatal MI, and non-fatal cardiac arrest.
We identified 105 SCAD patients (mean age 53 ± 11 years, 98
female, 5 peripartum). Presentation was myocardial infarction in all
patients. In 102 patients, there was one contiguous dissection.
Three patients had two (n = 2) or three (n = 1) non-contiguous
dissections. In the majority of patients (n = 97), the primary
treatment approach was conservative (dual antiplatelet therapy for
12 months in 90% of patients, statins in 91%). Seven patients were
treated with percutaneous coronary intervention (PCI) and one
patient underwent bypass surgery. Elective follow-up angiograms were
performed in 73 asymptomatic patients after a median follow-up of
6.0 months (interquartile range [IQR] 5.5-6.5). These showed healing
of the dissection (n = 65) or a good result after PCI (n = 5) in 70
patients. Three patients had a persistent dissection but
conservative treatment was continued. After a median follow-up of
7.5 years (IQR 3.6-12.5) (longest follow-up: 22.5 years) there were
15 MACE. Five MACE occurred within 30 days of the index event: death
following catastrophic peripartum left main SCAD (n = 1),
out-of-hospital cardiac arrest with successful resuscitation 16 days
after SCAD (n = 1), ST-segment elevation myocardial infarction due
to occlusion of the dissected artery 10 hours after the index
angiogram with subsequent PCI (n = 1), SCAD of a second vessel 8
days after the index SCAD (n = 1), and non-ST-segment elevation
myocardial infarction with persistent, multisite SCAD 10 days after
the index event (n = 1). There were 10 late MACE, including
myocardial infarction and recurrent SCAD (different vessel/lesion) a
median of 7.6 years (IQR 3.9-9.6) after the index event in eight
patients and death with unclear cause in two patients.
This SCAD series highlights its highly variable clinical course
during the acute phase and in the long term. Although most SCAD
patients can be treated conservatively with subsequent healing of
the dissection and good clinical outcome, there are also patients
with dramatic acute presentation or MACE several years after the
Seidl S, Rickli H, Rogowski S, Weilenmann D, Ammann P, Haager P K,
Jörg L, Rohner F, Chronis J, Rigger J, Maeder M T. Long-term
follow-up of medically treated patients with spontaneous coronary
artery dissection: a prospective, Swiss single-centre cohort study.
Swiss Med Wkly 2021; 151:w30067.