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Association of Spontaneous Coronary Artery Dissection With Atrial Arrhythmias

Alex D Tarabochia1, Nicholas Y Tan2, Bradley R Lewis3

  • 1Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.

The American Journal of Cardiology
|November 3, 2022
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) patients have a higher risk of developing atrial arrhythmias (AA), including atrial fibrillation and flutter. This risk is present both before and after SCAD events, highlighting a significant association.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Vascular Medicine

Background:

  • Spontaneous coronary artery dissection (SCAD) is a condition with incompletely understood long-term complications.
  • Atrial arrhythmias (AA), encompassing atrial fibrillation and atrial flutter, are common cardiovascular conditions.
  • The relationship between SCAD and the development of AA requires further investigation.

Purpose of the Study:

  • To investigate the association between spontaneous coronary artery dissection (SCAD) and atrial arrhythmias (AA).
  • To determine if AA occurs before, during, or after SCAD events.
  • To compare the incidence of AA in SCAD patients versus matched controls.

Main Methods:

  • Observational study involving two parts: a retrospective analysis of the Mayo Clinic SCAD Registry and a population-based case-control study.
  • Identified patients with SCAD and co-existing AA from the registry.
  • Compared AA incidence in SCAD patients against age- and gender-matched controls in the population-based cohort.

Main Results:

  • Of 1,214 SCAD patients, 3.7% had AA, with occurrences noted before (17.8%), during (44.4%), and after (37.8%) SCAD.
  • Population-based analysis showed SCAD patients were more likely to develop AA before SCAD (OR 4.5, p=0.04) and in the 10 years following SCAD (HR 6.3, p=0.03) compared to controls.
  • No significant associations were found with traditional cardiovascular risk factors in univariate analysis.

Conclusions:

  • Patients with SCAD have a significantly higher likelihood of developing atrial arrhythmias.
  • Atrial arrhythmias can precede, coincide with, or follow spontaneous coronary artery dissection.
  • Further research into the mechanisms and management of AA in SCAD patients is warranted.

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