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Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of myocardial infarction, especially in young women. A recent surge in recognition and diagnosis, coupled with increasing number of publications of large case series, have advanced our understanding of the early natural history, presenting characteristics, management and outcomes in this condition. However, a paucity of data exists regarding nature of symptoms reported by patients following the index SCAD event.
Patients with non-atherosclerotic SCAD prospectively followed at Vancouver General Hospital were included. Angiographic SCAD diagnosis was confirmed by 2 experienced cardiologists and categorized as type 1, 2 or 3. Characteristics including nature and frequency of cardiovascular symptoms reported during clinic visits throughout a 5-year follow-up period were recorded.
We prospectively evaluated 300 patients and reported their symptoms at 1 and 6 months post index event, and annually thereafter for up to 5 years. Average age was 52.7 ± 9.7 years and 90.3% were women. Median follow-up time was 3.0 (1.4 - 5.1) years. The most frequently reported chief symptom throughout follow-up period was atypical chest pain: 50.8% at 1 month, 42.5% at 6 months, 42.6% at 1 year, 39.6% at 2 years, 34.2% at 3 years, 34.8% at 4 years and 38.5% at 5 years. As expected, there is a slight reduction of symptoms overtime following the index event. There was also a change in the frequency of symptoms over time (Figure 1). Other less frequently reported symptoms were typical angina, dyspnea, and palpitations. The number of asymptomatic patients during the follow-up period were 38.4% at 1 month, 47.7% at 2 months, 50.6% at 1 year, 52.3% at 2 years, 58.6% at 3 years, 56.2% at 4 years, and 53.8% at 5 years.
Atypical chest pain is frequent after a SCAD event, with reduction in burden of symptoms over time. This is the first report outlining patient symptoms following their initial SCAD event.
CORONARY: Acute Coronary Syndromes