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Natural History of Spontaneous Coronary Artery Dissection With Spontaneous Angiographic Healing
Saber Hassan1, Roshan Prakash1, Andrew Starovoytov1
1Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Spontaneous coronary artery dissection (SCAD) often heals on its own, with most cases showing complete angiographic healing within 30 days. Repeat angiography confirms significant spontaneous healing in the majority of SCAD lesions.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction, particularly in women.
- The healing characteristics of arteries affected by SCAD are not well understood.
- This study addresses the uncertainty surrounding spontaneous healing in SCAD.
Purpose of the Study:
- To evaluate the angiographic features of spontaneous healing in a large cohort of patients with SCAD.
- To assess the prevalence and degree of spontaneous healing following SCAD.
- To investigate the time dependency of healing in SCAD lesions.
Main Methods:
- Prospective follow-up of patients with nonatherosclerotic SCAD who underwent repeat coronary angiography.
- Exclusion of patients treated with percutaneous coronary intervention for SCAD.
- Assessment of angiographic characteristics (stenosis severity, TIMI flow) at initial and follow-up angiography by experienced readers.
- Definition of angiographic healing criteria: improved stenosis, residual stenosis <50%, and TIMI flow grade 3.
Main Results:
- 156 patients with 182 SCAD lesions were analyzed; 88.5% were women.
- Type 2 SCAD was most common (69.2%), with initial TIMI flow <3 in 46.7% and median stenosis of 79%.
- Repeat angiography at a median of 154 days showed improved median stenosis to 25.5% and TIMI flow <3 in only 5.5% of lesions.
- Overall angiographic healing occurred in 86.3% of lesions.
- 95% of lesions showed spontaneous healing when repeat angiography was performed ≥30 days post-SCAD.
Conclusions:
- The majority of coronary arteries affected by SCAD demonstrate spontaneous healing.
- Healing appears to be time-dependent, with complete angiographic healing observed in most cases after 30 days.
- Repeat angiography is crucial for assessing the extent of spontaneous recovery in SCAD.
Objectives:
Given the uncertainty regarding the degree and prevalence of spontaneous healing following spontaneous coronary artery dissection (SCAD), the aim of this study was to assess the angiographic characteristics of the dissected segments in a large cohort of patients with SCAD who underwent subsequent repeat coronary angiography.
Background:
SCAD is an uncommon yet important cause of myocardial infarction in women. Very little is known about the characteristics of healing of dissected arteries.
Methods:
Patients with nonatherosclerotic SCAD followed prospectively at Vancouver General Hospital who underwent repeat angiography were included in this study. Those who underwent percutaneous coronary intervention for SCAD were excluded. Baseline patient demographics and in-hospital and long-term cardiovascular events were recorded. Angiographic characteristics of the SCAD artery at index and repeat angiography were assessed by 2 experienced angiographers. Criteria for angiographic healing were as follows: 1) improvement of stenosis severity from index event; 2) residual stenosis <50%; and 3) TIMI (Thrombolysis In Myocardial Infarction) flow grade 3.
Results:
One hundred fifty-six patients with 182 noncontiguous SCAD lesions were included. The mean age was 51.5 ± 8.7 years, 88.5% were women, 83.3% were Caucasian, and 75.6% had fibromuscular dysplasia. All patients presented with myocardial infarction. At index angiography, type 2 SCAD was most commonly observed, in 126 of 182 lesions (69.2%); TIMI flow grade <3 was present in 85 of 182 (46.7%); and median lesion stenosis was 79.0% (interquartile range: 56.0% to 100%). Median time to repeat angiography was 154 days (interquartile range: 70 to 604 days), with median residual lesion stenosis improving to 25.5% (interquartile range: 12.0 to 38.8 days), and TIMI flow grade <3 observed in 10 of 182 lesions (5.5%). Angiographic healing occurred in 157 of 182 lesions (86.3%). Of repeat angiography performed ≥30 days post-SCAD, 152 of 160 (95%) showed spontaneous angiographic healing.
Conclusions:
The majority of coronary arteries affected by SCAD heal spontaneously on repeat angiography, with apparent time dependency, with the vast majority having complete healing after 30 days from the SCAD event.
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