Canadian Spontaneous Coronary Artery Dissection Cohort Study: 3-Year Outcomes.

Area of Science:

• Cardiology
• Vascular Medicine
• Genetics

Background:

• Spontaneous coronary artery dissection (SCAD) is a significant cause of myocardial infarction (MI) in women.
• SCAD is a nonatherosclerotic condition requiring understanding of its long-term outcomes.

Purpose of the Study:

• To define the long-term natural history of spontaneous coronary artery dissection (SCAD).
• To identify predictors of major adverse cardiovascular events (MACE) in SCAD patients.

Main Methods:

• A multicenter, prospective, observational study enrolled 750 patients with nonatherosclerotic SCAD.
• Data collected included demographics, stressors, predisposing conditions, and angiographic features.
• Long-term outcomes, including MACE, were assessed over a median 3-year follow-up using Cox regression analysis.

Main Results:

• The cohort was predominantly women (88.5%), with a mean age of 51.7 years.
• Commonly reported stressors included emotional (50.3%) and physical (28.9%).
• Predisposing conditions included fibromuscular dysplasia (42.9%) and genetic disorders (1.6%).
• At 3-year follow-up, mortality was 0.8%, recurrent MI was 9.9%, and overall MACE was 14.0%.
• Genetic disorders, peripartum SCAD, and extracoronary fibromuscular dysplasia independently predicted 3-year MACE.
• Percutaneous coronary intervention (PCI) at index hospitalization did not increase postdischarge MACE compared to conservative management.

Conclusions:

• Long-term mortality and de novo recurrent SCAD are low in contemporary cohorts with high rates of aspirin and beta-blockade use.
• Genetic disorders, peripartum SCAD, and extracoronary fibromuscular dysplasia are independent predictors of long-term MACE.
• Conservative management was common and associated with similar MACE rates as PCI.