Characterization of recurrent coronary dissections/non-coronary dissections in Japanese patients with spontaneous coronary artery dissection: Clinical implications of β1-selective blockers and calcium-channel blockers

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is characterized by coronary and symptomatic extra-coronary artery dissections. However, factors associated with SCAD-related complications remain unclear. METHODS: The ISCAD-CATCH was a multicenter observational study that enrolled 566 Japanese patients with SCAD. Clinical characteristics of those with and without major adverse dissection-related cardiovascular events (MADCE = cardiac death+recurrent SCAD+symptomatic extra-coronary artery dissection) were compared. RESULTS: During the 1490-day observational period (interquartile range = 352-2242 days), 13.4 % of the study participants experienced MADCE (cardiac death = 1.2 %; recurrent SCAD = 10.9 %; symptomatic non-coronary artery dissection = 1.6 %). Patients with SCAD experiencing MADCE were younger (47.5 ± 10.5 vs. 51.0 ± 10.7 years, p = 0.006) and had a greater frequency of multi-vessel coronary dissections (21.1 vs. 12.7 %, p = 0.048), primary PCI (56.6 vs. 43.3 %, p = 0.030), and mechanical circulatory support (15.8 vs. 6.9 %, p = 0.009). Furthermore, patients with MADCE more frequently received calcium-channel blockers (53.9 vs. 39.2 %, p = 0.015), whereas they were less likely treated with β1-selective blockers (18.4 vs. 33.7 %, p = 0.008). Multivariate analysis revealed that age (hazard ratio [HR] = 0.975, 95 % confidence interval [CI] = 0.953-0.997, p = 0.029), β1-selective blockers (HR = 0.520, 95 %CI = 0.279-0.967, p = 0.039), and calcium channel blockers (HR = 1.682, 95 %CI = 1.051-2.691, p = 0.030) were independently associated with MADCE. The frequency of MADCE increased to 30.6 % in patients with SCAD aged <50 years, non-usage of β1-selective blockers, and use of calcium-channel blockers (HR = 3.215, 95 %CI = 2.000-5.166, p < 0.001). CONCLUSIONS: Approximately 13 % of Japanese patients with SCAD experienced MADCE. MADCE risk increased with age, non-usage of β1-selective blockers, and the use of calcium-channel blockers. Medical therapies need to be adequately selected to mitigate the future risks of MADCE after SCAD.