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Clinical Implications of the "Broken Line" Angiographic Pattern in Patients With Spontaneous Coronary Artery

Fernando Alfonso1, Ricardo Sanz-Ruiz2, Manel Sabate3

  • 1Cardiac Department, Hospital Universitario de la Princesa, IIS-IP, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.

The American Journal of Cardiology
|October 16, 2022
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) patients with the "broken line" (BKL) pattern on angiography, often female with intramural hematoma, experience better initial coronary flow and fewer adverse events. This BKL morphology indicates a favorable prognosis in SCAD cases.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Vascular Medicine

Background:

  • Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute myocardial infarction.
  • Coronary angiography is crucial for SCAD diagnosis, but interpretation requires expertise.
  • The clinical significance of specific angiographic patterns in SCAD is not fully understood.

Purpose of the Study:

  • To evaluate the clinical implications of the "broken line" (BKL) angiographic pattern in SCAD patients.
  • To assess the association between the BKL pattern and patient characteristics, lesion morphology, and clinical outcomes.

Main Methods:

  • Analysis of a large, nationwide cohort of SCAD patients from the Spanish SCAD registry (NCT03607981).
  • Centralized review of all angiograms to systematically assess the BKL pattern.
  • Comparison of clinical, angiographic, and outcome data between patients with and without the BKL pattern.

Main Results:

  • The BKL pattern was identified in 16% of SCAD patients.
  • BKL patients were more frequently female, presented with intramural hematoma, had longer lesions, and severe tortuosity, but showed better initial coronary flow.
  • BKL patients received more conservative management and experienced significantly fewer adverse events at late follow-up (3.5% vs. 15%), with a favorable prognosis even after adjusting for confounders.

Conclusions:

  • The BKL angiographic pattern in SCAD is associated with specific patient and lesion characteristics, including a higher prevalence in females and presentation as intramural hematoma.
  • Despite complex lesion morphology, SCAD patients with the BKL pattern exhibit improved initial coronary flow.
  • The BKL angiographic morphology signifies a favorable prognosis in SCAD, with a substantially lower risk of adverse clinical events.

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