Author + information
- Jacqueline W.L. Saw,
- Andrew Starovoytov,
- Yinshan Zhao,
- Defen Peng and
- Karin Humphries
Background: 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, but the predictors of recurrent SCAD have not been explored.
Methods: We included patients with non-atherosclerotic SCAD enrolled in the Vancouver General Hospital 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 Cox regression models, 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, multi-vessel SCAD, catheter-induced dissection, and need for revascularization.
Results: 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; 50.7% reported emotional stress, and 28.2% reported physical stressor. FMD was present in 63.6%, CTD in 3.2% and SID in 9.6%. Catheter-induced dissection occurred in 4.3%. 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, hypertension and catheter-induced dissection were the only independent predictors of recurrent SCAD (HR 2.5, 95% CI 1.3-5.0, p=0.010; HR 5.6, 95% CI 1.9-16.7, p=0.002).
Conclusions: In our large prospectively followed cohort of SCAD patients, hypertension and catheter-induced dissection were the only independent predictors of recurrent SCAD.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Unusual Presentations of ACS
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1297-319
- 2017 American College of Cardiology Foundation