Spontaneous Coronary Artery Dissection: Clinical Characteristics, Management, and Outcomes in a Racially and
Stephanie Chen1, Maqdooda Merchant2, Kenneth N Mahrer1
1Kaiser Permanente San Francisco Medical Center, CA.
The Permanente Journal
|January 14, 2020
Summary
Spontaneous coronary artery dissection (SCAD) predominantly affects women, with pregnancy and hyperlipidemia as key associated factors. While major adverse cardiovascular events were infrequent, recurrent chest pain was common in SCAD patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Epidemiology
Background:
- Spontaneous coronary artery dissection (SCAD) is a significant cause of acute coronary syndrome (ACS).
- SCAD disproportionately affects healthy women, yet this population's characteristics remain underdefined.
- Understanding SCAD's vulnerable population is crucial for effective management.
Purpose of the Study:
- To identify the demographic and clinical characteristics of patients diagnosed with SCAD.
- To determine the in-hospital and long-term outcomes for patients with SCAD within a community-based cohort.
- To explore factors associated with SCAD in a diverse patient population.
Main Methods:
- Retrospective cohort study design.
- Inclusion of 111 SCAD cases and 333 matched healthy controls from Kaiser Permanente Northern California over a 10-year period.
- Analysis of predisposing factors, treatment modalities, and patient outcomes.
Main Results:
- The SCAD cohort (mean age 48.1 years) was 92.8% female and 49.5% nonwhite.
- Pregnancy and hyperlipidemia were significantly associated with SCAD compared to controls.
- Major adverse cardiovascular events occurred in 8.1% of SCAD patients over 2.6 years median follow-up; 54% experienced recurrent chest pain.
Conclusions:
- The study highlights a racially and ethnically diverse SCAD cohort, with pregnancy and hyperlipidemia as primary associated factors.
- Pregnancy-related SCAD did not correlate with worse outcomes, but recurrent chest pain was a frequent issue.
- Race was not found to influence SCAD outcomes in this cohort.
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