Left Main Spontaneous Coronary Artery Dissection: Clinical Features, Management, and Outcomes.
Michele Morosato1, Carlo Gaspardone2, Davide Romagnolo3
1Vita-Salute San Raffaele University, Milan, Italy.
JACC. Cardiovascular Interventions
|April 10, 2025
Summary
Left main spontaneous coronary artery dissection (SCAD) is a rare, life-threatening condition. Early revascularization significantly reduces adverse outcomes compared to conservative management for LM SCAD.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction (MI).
- Left main (LM) SCAD is a rare, potentially life-threatening variant with limited reported data.
- This study addresses the scarcity of information on LM SCAD.
Purpose of the Study:
- To investigate the clinical features of patients diagnosed with LM SCAD.
- To analyze contemporary management strategies for LM SCAD.
- To evaluate the clinical outcomes associated with LM SCAD.
Main Methods:
- Systematic review and pooled analysis of published case reports.
- Keywords: "left main" and "dissection".
- Screened 1,106 papers from MEDLINE and Embase (1990-2023).
Main Results:
- 132 patients with LM SCAD included (mean age 40±11 years, 80% women).
- 36% of cases occurred during pregnancy; 95% presented with acute coronary syndrome.
- Early revascularization (PCI or CABG) significantly reduced composite adverse outcomes (aHR: 0.37; P<0.001) versus conservative management.
Conclusions:
- LM SCAD is associated with significant acute morbidity and mortality.
- Early revascularization, including percutaneous coronary intervention or coronary artery bypass grafting, improves outcomes.
- Further prospective studies are needed to confirm these findings.
Keywords:
acute coronary syndrome(s)cardiogenic shockischemic heart diseasemyocardial infarctionspontaneous coronary artery dissectionMore Related Videos
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