Conservative versus percutaneous treatment in spontaneous coronary artery dissection: clinical outcomes and survival analysis from a 10-year single-centre experience

Background Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome (ACS), mainly affecting young women. Optimal management remains uncertain; conservative therapy is generally preferred, while percutaneous coronary intervention (PCI) is reserved for persistent ischaemia or extensive dissection. Purpose To compare clinical presentation, angiographic features, and outcomes of patients with SCAD managed conservatively versus those undergoing PCI. Methods We retrospectively analysed 64 consecutive patients with angiographically confirmed SCAD admitted between November 2009 and August 2025. One patient treated with coronary artery bypass grafting (CABG) for left main and multivessel involvement was excluded from the comparative analysis. Clinical, angiographic, and follow-up data were collected. Statistical analyses included chi-square, t-test or Mann–Whitney, ANOVA, Kaplan–Meier survival, and Cox regression. Results Among 63 patients, 58 (92.1%) were treated conservatively and 5 (7.9%) underwent PCI. Median follow-up was 30 months (IQR 18–54). Baseline characteristics were similar, except for higher multivessel involvement and more severe stenosis in the PCI group. In-hospital outcomes were favourable, with no difference in complication rates (12.3% vs 12.5%; p = 0.86). During follow-up, rates of MACE (12.3% vs 12.5%; p = 0.72), recurrent chest pain (15.4% vs 12.5%; p = 0.95), and inducible ischaemia (6.2% vs 0%; p = 0.49) were comparable. Functional recovery, assessed by left ventricular ejection fraction and repeat angiography, was similar. At follow-up, TIMI 3 flow was achieved in most patients, with complete lesion healing in 40% of conservative and 60% of PCI-treated cases (p = 0.39). Restenosis rates were also similar (36.4% vs 27.3%; p = 0.41). Neither logistic regression nor Cox analysis identified independent predictors of MACE, and Kaplan–Meier analysis confirmed comparable event-free survival (log-rank = 0.10; p = 0.75). Both strategies yielded excellent mid-term outcomes with low event rates. Conclusions In this single-centre cohort, conservative management remained predominant and was associated with excellent survival, low MACE incidence, and good functional recovery. No significant differences in clinical, ischaemic, or symptomatic outcomes were observed between conservative and PCI-treated patients. Although limited by small PCI numbers, these findings support current recommendations favouring an initial conservative strategy, while emphasising the importance of functional and symptomatic monitoring during follow-up. Keywords: Spontaneous coronary artery dissection; SCAD; Conservative management; Percutaneous coronary intervention; PCI; Clinical outcomes.Event-free survival Table Treatment