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Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in young women. Recurrent SCAD after the first SCAD presentation is frequent and accounts for the majority of recurrent MI events on follow-up. However, the predictors of recurrent SCAD have not been explored.
Vancouver General Hospital is the quaternary referral center for SCAD patients throughout British Columbia and surrounding provinces. In this study, we included patients with recurrent SCAD from our prospectively followed consecutive cohort of non-atherosclerotic SCAD patients enrolled in our SCAD registries. Baseline demographics, angiographic characteristics, predisposing/precipitating factors, and cardiovascular events were recorded. Predictors of recurrent SCAD (extension of dissections or new dissections) were explored in univariate and multivariate analyses, including age, sex, hypertension, emotional stress, physical stressor, fibromuscular dysplasia (FMD), connective tissue disease (CTD), systemic inflammatory disease (SID), active hormonal therapy, left ventricular (LV) function, and multi-vessel SCAD.
We prospectively followed 280 patients at our SCAD clinic. Average age was 52.4±9.4yrs and majority were women (90.0%). All presented with MI, 23.9% with STEMI and 76.1% with NSTEMI. Patients had low cardiovascular risk factors overall, but 36.4% had hypertension, 50.7% reported emotional stress, and 28.2% reported physical stressor. FMD was present in 63.6% (19.6% incomplete or not screened), CTD in 3.2% and SID in 9.6%. Mean LV function was 55.9±9.6%, and 12.1% had multi-vessel SCAD. At median follow-up of 2.6 yrs (95% CI 2.4-3.0), mortality was 1.4%, recurrent MI 19.3%, recurrent SCAD 12.5%, and stroke/TIA 1.4%. Of the 35 recurrent SCAD cases, all presented with repeat MI. In our univariate and multivariable analyses, only hypertension was a predictor of recurrent SCAD (HR 2.2, 95% CI 1.1-4.3, p=0.028).
In our large prospectively followed cohort of SCAD patients, hypertension was the only independent predictor of recurrent SCAD. Future studies should explore this relationship further and the management implications.
CORONARY: Acute Myocardial Infarction