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Characteristics, Management, and Prognosis of Spontaneous Coronary Intramural Hematoma
Shufu Chang1, Yuxiang Dai1, Xiaoyue Song1
1Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, 92323Fudan University, shanghai, China.
Insights
Spontaneous coronary intramural hematoma (SCIH), a type of coronary artery dissection, is often misdiagnosed. Conservative management is preferred for SCIH, showing good prognosis and complete healing in most patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Spontaneous coronary intramural hematoma (SCIH) is a subtype of spontaneous coronary artery dissection, characterized by the absence of an intimal tear.
- SCIH can be challenging to diagnose, often leading to misdiagnosis in clinical practice.
Purpose of the Study:
- To investigate the clinical characteristics, management strategies, and long-term prognosis of patients diagnosed with SCIH.
- To identify key features and optimal treatment pathways for SCIH.
Main Methods:
- Retrospective analysis of 30 patients diagnosed with SCIH via coronary angiography between January 1, 2012, and December 31, 2018.
- Collection and review of demographic data, medical history, treatment interventions, and follow-up outcomes.
Main Results:
- The average patient age was 51.8 years, with a predominance of female patients (66.7%), frequently presenting with hypertension.
- Diffuse lesions were most common (70%), and conservative treatment was the primary approach (76.7%).
- Follow-up imaging (coronary CT or angiography) demonstrated complete resolution of SCIH in all evaluated patients, with no unplanned readmissions.
Conclusions:
- SCIH is most prevalent in post-menopausal women with hypertension.
- Avoiding antiplatelet therapy may be beneficial in SCIH management.
- Conservative treatment and allowing the hematoma to resolve naturally is a preferred strategy with a favorable prognosis.
Abstract:
Spontaneous coronary intramural hematoma (SCIH) was one type of spontaneous coronary artery dissection without obvious intimal tear, which is easy to misdiagnose. We aimed to study the characteristics, management, and prognosis of SCIH in our center. All the SCIH patients (n = 30) diagnosed by coronary angiography from January 1, 2012 to December 31, 2018 were enrolled. The demographic characteristics, history, therapy, and follow-up were collected. The mean age of the patients was 51.8 ± 9.5 years. Most of the patients were females (66.7%) with hypertension. Patients with diffuse lesion, focal lesion, and multiple vessels were 70%, 13.3%, and 16.7%, respectively. Conservative treatment was the first choice (76.7%). The mean follow-up time was 29.3 ± 13.5 months. None of the patients had unplanned readmission due to worsening symptoms. Nine patients underwent coronary artery computed tomography reexamination after 10.3 ± 7.5 months, which showed complete recovery of SCIH. Eight patients were hospitalized for coronary angiography 6.4 ± 4.7 months later, which did not show any sign of SCIH. Spontaneous coronary intramural hematoma was most common in post-menopausal women with hypertension. Possibly, antiplatelet drugs should be avoided in SCIH. Waiting for the hematoma to heal was preferable and had a good prognosis.
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