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Spontaneous coronary artery dissection (SCAD) is an important but often missed etiology for myocardial infarction (MI). Angiographic healing of SCAD affected arteries is typically observed, but little is known about the characteristics and time-interval for healing.
Patients with non-atherosclerotic SCAD prospectively followed at Vancouver General Hospital and enrolled in our SCAD registries were reviewed; those who had repeat coronary angiograms were included in this study. Baseline characteristics, index and follow-up coronary angiography were qualitatively assessed for 2 experienced angiographers for SCAD angiographic classification, TIMI-flow, stenosis severity, and left ventricular function. Follow-up angiography was examined for healing, defined as a triad of residual stenosis <50%, improvement of stenosis severity from baseline, and improvement or normalization of TIMI-flow. Patients who underwent percutaneous coronary intervention (PCI) of the dissected artery were excluded.
There were 146 patients with repeat angiography; 25 had PCI and were excluded. A total of 121 patients with 131 non-contiguous lesions were included in this analysis. The mean age was 51.7 ± 7.5 years, 88.4% were women, and 81.0% Caucasian. All presented with MI. At index angiogram, type 2 angiographic SCAD was most common 97/131 (74.1%), followed by type 1 (19.8%) and 3 (6.1%). LAD was most frequently affected 64/131 (48.9%). TIMI-0 flow was observed in 45/131 (34.4%), and the median segment stenosis was 90%, (IQR 80-100). The median time-interval to follow-up angiography was 5.1 months (IQR 2.3-16.6). On follow-up angiography, the median segment stenosis improved to 10% (IQR 0-20). Overall, healing was observed in 116/131 lesions (88.5%). Importantly, healing was observed in all lesions (n=113; 91.2% ≤30% stenosis) where angiography was repeated after 5 weeks of index event. Of the 15 unhealed segments, all angiograms were performed <35 days after event (7 for recurrent MI, 4 recurrent symptoms, 2 to confirm diagnosis).
Majority of SCAD arteries heal spontaneously, with healing typically observed after 5 weeks from index event on repeat angiography.
CORONARY: Acute Coronary Syndromes