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Prevalence and Disease Spectrum of Extracoronary Arterial Abnormalities in Spontaneous Coronary Artery Dissection
Alexandre Persu1,2, Marilucy Lopez-Sublet3,4, Abtehale Al-Hussaini5
1Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Insights
Spontaneous coronary artery dissection (SCAD) is linked to fibromuscular dysplasia (FMD) and other arterial issues. However, severe extracoronary abnormalities and events are infrequent in SCAD patients.
Area of Science:
- Cardiovascular Imaging and Intervention
- Vascular Biology and Disease
Background:
- Spontaneous coronary artery dissection (SCAD) is increasingly recognized, often associated with fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities.
- The precise prevalence, severity, and clinical significance of these extracoronary findings in SCAD patients remain incompletely understood.
Purpose of the Study:
- To determine the prevalence and spectrum of fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities in patients diagnosed with SCAD.
- To compare the frequency and characteristics of these abnormalities between SCAD patients and a healthy control group.
Main Methods:
- A case series of 173 patients with confirmed SCAD underwent head-to-pelvis magnetic resonance angiography (MRA).
- Forty-one healthy individuals served as controls for blinded MRA interpretation.
- Fibromuscular dysplasia (FMD), dissections, and aneurysms were diagnosed using the International FMD Consensus criteria; arterial tortuosity was assessed quantitatively and qualitatively.
Main Results:
- Fibromuscular dysplasia (FMD) was identified in 31.8% of SCAD patients, with 29.1% of those having multi-vessel involvement.
- Extracoronary aneurysms were present in 7.5% and dissections in 1.7% of SCAD patients.
- Arterial tortuosity was similar between SCAD patients and controls; no primary extracoronary vascular events occurred during a median 5-year follow-up.
Conclusions:
- While imaging detects extracoronary arteriopathies in SCAD patients, severe multivessel FMD, aneurysms, and dissections are infrequent.
- Extracoronary vascular events appear to be rare in this population, suggesting that comprehensive vascular screening may identify abnormalities requiring monitoring but not necessarily leading to acute events.
Importance:
Spontaneous coronary artery dissection (SCAD) has been associated with fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities. However, the prevalence, severity, and clinical relevance of these abnormalities remain unclear.
Objective:
To assess the prevalence and spectrum of FMD and other extracoronary arterial abnormalities in patients with SCAD vs controls.
Design, Setting, And Participants:
This case series included 173 patients with angiographically confirmed SCAD enrolled between January 1, 2015, and December 31, 2019. Imaging of extracoronary arterial beds was performed by magnetic resonance angiography (MRA). Forty-one healthy individuals were recruited to serve as controls for blinded interpretation of MRA findings. Patients were recruited from the UK national SCAD registry, which enrolls throughout the UK by referral from the primary care physician or patient self-referral through an online portal. Participants attended the national SCAD referral center for assessment and MRA.
Exposures:
Both patients with SCAD and healthy controls underwent head-to-pelvis MRA (median time between SCAD event and MRA, 1 [IQR, 1-3] year).
Main Outcome And Measures:
The diagnosis of FMD, arterial dissections, and aneurysms was established according to the International FMD Consensus. Arterial tortuosity was assessed both qualitatively (presence or absence of an S curve) and quantitatively (number of curves ≥45%; tortuosity index).
Results:
Of the 173 patients with SCAD, 167 were women (96.5%); mean (SD) age at diagnosis was 44.5 (7.9) years. The prevalence of FMD was 31.8% (55 patients); 16 patients (29.1% of patients with FMD) had involvement of multiple vascular beds. Thirteen patients (7.5%) had extracoronary aneurysms and 3 patients (1.7%) had dissections. The prevalence and degree of arterial tortuosity were similar in patients and controls. In 43 patients imaged with both computed tomographic angiography and MRA, the identification of clinically significant remote arteriopathies was similar. Over a median 5-year follow-up, there were 2 noncardiovascular-associated deaths and 35 recurrent myocardial infarctions, but there were no primary extracoronary vascular events.
Conclusions And Relevance:
In this case series with blinded analysis of patients with SCAD, severe multivessel FMD, aneurysms, and dissections were infrequent. The findings of this study suggest that, although brain-to-pelvis imaging allows detection of remote arteriopathies that may require follow-up, extracoronary vascular events appear to be rare.
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