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Prognostic Value of Cardiac MRI for Acute Spontaneous Coronary Artery Dissection: A Prospective Cohort Study
Andrea Biondo1, Victor Schweiger2,3, Rabea Schlenker1,2
1Diagnostic and Interventional Radiology, University Hospital Zurich, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland.
Insights
Spontaneous coronary artery dissection (SCAD) type 1 and extensive late gadolinium enhancement (LGE) on cardiac MRI predict major adverse cardiac events (MACEs). These findings aid in risk stratification for SCAD patients.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Interventional Cardiology
- Radiology
Background:
- Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome, particularly in younger women.
- Predictors of major adverse cardiac events (MACEs) in SCAD patients require further elucidation.
- Cardiac magnetic resonance (CMR) imaging offers detailed assessment of myocardial injury and SCAD characteristics.
Purpose of the Study:
- To identify baseline clinical characteristics and CMR parameters that predict MACEs in SCAD patients.
- To evaluate the association between SCAD classification, myocardial injury extent, and adverse cardiac outcomes.
- To establish CMR-based risk stratification markers for SCAD.
Main Methods:
- Prospective single-center study of 59 SCAD patients diagnosed via angiography.
- Cardiac MRI performed median 4 days post-symptom onset; SCAD classified by Yip-Saw system.
- Follow-up for MACEs; statistical analysis using logistic and Cox regression, focusing on late gadolinium enhancement (LGE).
Main Results:
- SCAD type 1 and transmural LGE independently predicted MACEs (HR 10.00, P=.002; HR 1.50, P=.006, respectively).
- ST-elevation myocardial infarction at presentation predicted greater LGE extent (OR 7.00, P=.02).
- More than three transmural LGE segments identified a critical risk zone for MACEs.
Conclusions:
- SCAD type 1 is a significant independent predictor of MACEs.
- Extent of transmural LGE on acute cardiac MRI, particularly >3 segments, independently predicts MACEs in SCAD.
- Cardiac MRI parameters, including LGE extent, are valuable for risk stratification in SCAD patients.
Abstract:
Purpose To determine whether baseline clinical characteristics and cardiac MRI parameters predict major adverse cardiac events (MACEs) in participants with angiographically confirmed spontaneous coronary artery dissection (SCAD). Materials and Methods This prospective single-center study included participants with SCAD who were angiographically diagnosed between March 2018 and November 2023. Cardiac MRI was performed after a median of 4 days (IQR, 1.5-7) from symptom onset. SCAD types were classified according to the Yip-Saw system. Follow-up evaluation was performed at a median of 5.5 months after discharge, and MACEs were recorded. The primary outcome was the occurrence of MACEs. Secondary analyses included extent of late gadolinium enhancement (LGE). Statistical analysis included binary logistic and Cox proportional hazards regression. Results Overall, 59 participants (mean age, 49 years ± 10; 40 female participants [68%]) were included. ST-elevation myocardial infarction at presentation was diagnosed in 24 of 59 (41%). Angiographically, 41 of 59 (69.5%) were SCAD type 2. Baseline cardiac MRI demonstrated acute injury in 48 of 59 (81%) and LGE in 54 of 59 (93%), typically moderate (median, three segments [IQR, two to five]). In the adjusted model, ST-elevation myocardial infarction manifestation independently predicted greater LGE extent (P = .02; odds ratio, 7.00; 95% CI: 2.00, 24.00). After multivariable adjustment, SCAD type 1 was significantly associated with MACEs (P = .002; hazard ratio, 10.00; 95% CI: 2.00, 23.00), as was transmural LGE (P = .006; hazard ratio, 1.50; 95% CI: 1.10, 2.10). A threshold of greater than or equal to four LGE segments identified a critical risk zone. Conclusion In SCAD, SCAD type 1 and involvement of more than three transmural LGE segments at acute cardiac MRI independently predicted MACEs. Keywords: MR Perfusion, Cardiac, Arteries, Cardiomyopathies, Ischemia/Infarction Supplemental material is available for this article. © RSNA, 2026.
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