Spontaneous coronary artery dissection cohort study: A nationwide Tunisian series

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) but remains insufficiently characterized. This study aimed to evaluate early and long-term outcomes of patients with SCAD.

A national wide, 25-year (since 2000), study with prospective (since 2017) inclusions of patients presenting for ACS with documented SCAD. Primary endpoint was in-hospital and long term major adverse cardiac and cerebrovascular events (MACCE).

87 patients. Mean age 47.5±11 years, 71% female, 84% had no or only one conventional cardiovascular risk factor. Pregnancy-associated (P-SCAD) accounted for 9%. ST-segment elevation myocardial infarction and cardiogenic shock were described in 51% and 7%. 101 SCAD lesions (60% type 1, 37% type 2 and 3% type 3) were noted. Left anterior descending was the most affected vessel (72%), multivessel involvement was observed in 26% and severe tortuosities were reported in 38%. Conservative strategy was possible in 84% of patients; among them 15% required subsequent urgent clinically driven revascularization. Coronary angiography and percutaneous interventions were associated with five major complications of which one was fatal. Six in-hospital deaths were reported (7%), 4 of them were P-SCAD. After 16-month median follow-up, overall major events and mortality rates were 17% and 9% respectively. Two SCAD recurrences were reported.

SCAD affected a middle-aged, predominantly female population, with no or few conventional risk factors. In-hospital mortality was high especially in P-SCAD. Coronary angiography and interventions for SCAD were associated with frequent complications, and a conservative management should be preferred when possible.