Prevalence of ascending aortic dilation in patients with spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, particularly in younger women, and is frequently associated with systemic vascular abnormalities. However, the prevalence and clinical significance of ascending aortic dilation in SCAD remain poorly defined.

We conducted a retrospective, multicenter cohort study of patients ≥20 years old with angiographically confirmed SCAD at Mayo Clinic campuses from 2018 to 2024. Transthoracic echocardiography was used to measure aortic dimensions at the sinus of Valsalva and mid-ascending aorta, with dilation defined by age-, sex-, and body surface area-adjusted reference values.

Among 937 patients with SCAD, 189 (20.2 %) demonstrated ascending aortic dilation. Dilation was most commonly located at the mid-ascending aorta (70.9 %). Prevalence increased with age (p = 0.009) and was significantly associated with hypertension (48.7 % in the dilation group vs. 33.3 % in the non-dilated group, p < 0.001). Patients with aortic dilation also had higher rates of extracoronary aneurysms, particularly involving the celiac, splenic, and splanchnic arteries. Thoracic aortic dissection was rare, observed in 0.4 % of patients.

Ascending aortic dilation was identified in approximately one-fifth of patients with SCAD, substantially higher than reported in the general population. These findings support SCAD as a systemic vascular disorder and highlight the potential role of baseline aortic assessment at diagnosis. The association with age and hypertension suggests both intrinsic vascular susceptibility and traditional risk factors contribute to this phenotype. Future prospective studies are needed to define progression, clinical consequences, and surveillance strategies.