Journal of Invasive Cardiology

ABSTRACT: Background. Spontaneous coronary artery dissection (SCAD) is a rare condition that commonly presents as an acute coronary event in the younger population, especially in females of childbearing age. Generally, there is no consensus on the etiology, prognosis, and treatment of SCAD. Methods. The Medline database was searched for “spontaneous coronary artery dissection” between 1931 and 2008. A total of 440 cases of SCAD were identified. Demographic data were analyzed with either the Student’s t-test or the chi-square test for categorical and nominal variables, respectively. Kaplan-Meier outcome analysis was used to assess the outcome of a given treatment for all patients after 1990. Result. SCAD was found more commonly in females with 308 (70%) cases. Pregnancy was associated with SCAD in 80 (26.1%) cases. Among pregnant patients, 67 (83.8%) developed SCAD in the postpartum period and 13 (16.2%) patients in the prepartum period. Analysis of treatment modalities showed that 21.2% of the patients who were conservatively managed after the initial diagnosis eventually required surgical or catheter-based intervention compared to 2.5% of patients who were initially treated with an aggressive strategy. Kaplan-Meier analysis showed that patients with an isolated single lesion in left or right coronary artery had a statistically significant better outcome when treated with an early aggressive strategy, including coronary artery bypass grafting (CABG) or stent placement as compared to a conservative strategy (p = 0.023, p = 0.006, respectively). Conclusion. Early intervention with either CABG or percutaneous coronary intervention following the diagnosis of SCAD leads to a better outcome and less need for further intervention.

J INVASIVE CARDIOL 2010;22:222–228

Spontaneous coronary artery dissection (SCAD) is a separation of the coronary artery wall layers by hemorrhage with or without an associated intimal tear.¹ It is a rare condition that mainly presents in the younger female population,^2,3 and typically manifests as an acute coronary event. The first known case was documented in an autopsy performed on a 42-year-old female in 1931. ⁴ Since then, a number of anecdotal references have been made in the literature.

Previously, diagnosis was mainly made by postmortem examination until the advent of advanced cardiac imaging. Now, more cases of SCAD are being diagnosed with the widespread use of coronary angiography. SCAD can involve both the left and right coronary arterial system. The treatment modalities consist of conservative medical or aggressive management with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Currently, there are no outcome studies or treatment guidelines for SCAD. The purpose of this study is to compare the effectiveness of various treatment modalities on the outcome of SCAD.