Mortality, recurrence low at 3 years in large SCAD cohort
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In a large cohort of patients with spontaneous coronary artery dissection, the rates of mortality and recurrent spontaneous coronary artery dissection were low at 3 years, researchers reported.
Most of the patients were not revascularized, and many were treated with aspirin and/or beta-blockers, according to the findings published in the Journal of the American College of Cardiology.
Jacqueline Saw, MD, interventional cardiologist at Vancouver General Hospital and St. Paul’s Hospital, program director of the Vancouver General Hospital Interventional Cardiology Fellowship Program and clinical assistant professor of medicine at the University of British Columbia, and colleagues conducted a prospective study of 750 patients with spontaneous coronary artery dissection (SCAD) enrolled between June 2014 and June 2018 at 22 North American centers.
Among the cohort, the mean age was 52 years, 88.5% were women (55% postmenopausal), 31.3% presented with STEMI and 68.3% presented with non-STEMI. In addition, 50.3% had a precipitating emotional stressor and 28.9% had a precipitating physical stressor, whereas 42.9% had fibromuscular dysplasia, 4.5% were in a peripartum state and 1.6% had a predisposing genetic disorder.
Most (84.3%) patients received conservative treatment, 14.1% had PCI and 0.7% had CABG, Saw and colleagues wrote.
Death, recurrence rates
At a median follow-up of 3 years, 0.8% died, 14% had a major adverse CV event and 9.9% had a recurrent MI (3.5% with extension of previous SCAD, 2.4% with de novo recurrent SCAD and 1.9% with iatrogenic dissection), according to the researchers.
Independent predictors of major adverse CV events at 3 years included presence of a genetic disorder (HR = 5.05; P < .001), peripartum status (HR = 2.17; P = .027) and extracoronary fibromuscular dysplasia (HR = 1.51; P = .038).
The rates of major adverse CV events at 3 years did not differ between those who had PCI at index hospitalization and those who did not, Saw and colleagues found.
At 3 years, 80% of patients were taking aspirin and 73.5% were taking beta-blockers, and medication use was not related to risk for major adverse CV events, the researchers wrote.
“Our finding of low major adverse CV event rates and mortality out to 3 years is remarkably low compared with older published reports,” Saw and colleagues wrote. “Previously, major adverse CV event rates of up to 30% were reported at follow-up of 2 to 3 years, mostly caused by recurrent MI from recurrent SCAD, which was reported in 15% to 22% of patients. ... In our current large study, the prospective enrollment of consecutive patients presenting to hospitals acutely with SCAD minimized patient selection bias, thereby providing a more accurate estimate of the natural history of SCAD.”
‘Deserves a close analysis’
In a related editorial, Alexandre Persu, MD, PhD, head of the Hypertension Clinic, Cardiology Department, Cliniques Universitaires Saint-Luc Université Catholique de Louvain, Brussels, and colleagues wrote that the study “suggests a better prognosis and decreased SCAD recurrence rate in less selected, more representative SCAD patients. It deserves a close analysis by all those interested in diagnosis and care of patients with SCAD and provides further motivation for clinical trials in this disease.”
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