Spontaneous coronary artery dissection: insights from computed tomography coronary angiography follow-up

Area of Science:

• Cardiology
• Medical Imaging
• Vascular Biology

Background:

• Spontaneous Coronary Artery Dissection (SCAD) is a significant cause of myocardial infarction, particularly in women.
• Accurate assessment of SCAD healing is crucial for patient management and prognosis.
• Computed Tomography Coronary Angiography (CTCA) is a non-invasive imaging modality used to evaluate SCAD.

Purpose of the Study:

• To determine the optimal timing for follow-up CTCA to assess dissection healing in SCAD patients.
• To evaluate the diagnostic performance of CTCA in assessing SCAD healing at different time points.

Main Methods:

• Retrospective analysis of patients with SCAD who underwent follow-up CTCA between 2010 and 2018.
• CTCA interpretation by two cardiologists, one blinded to SCAD location.
• Assessment of dissection healing and calculation of optimal CTCA timing.

Main Results:

• 32 patients with 38 SCAD lesions were included; 65.8% showed healing at a median follow-up of 40.5 days.
• Blinded CTCA reporting showed 72% sensitivity and 53.8% specificity for assessing healing.
• Optimal timing for CTCA to assess healing was determined to be 80 days (AUC 0.774).
• Healing rates were lower with early CTCA (<80 days, 12.5%) compared to late CTCA (≥80 days, 71.4%).

Conclusions:

• CTCA's utility in diagnosing SCAD, especially in distal vessels, is limited by resolution.
• The optimal timing for CTCA to assess spontaneous coronary artery dissection healing is approximately 80 days post-event.