What is the clinical evidence from this study?

Study design: Cohort. Population: Spontaneous Coronary Artery Disease (SCAD) (n=86). Intervention: Coronary tortuosity vs. Non-tortuous coronary anatomy. Primary outcome: Unplanned revascularization (OR 7.64, 95% CI 1.84-31.62, p=0.006).

October 27, 2025BMC Cardiovascular Disorders1 citationsOpen Access

Unplanned revascularization and major adverse cardiac events in spontaneous coronary artery disease patients: insights from a cardiac center

Q: What does this research mean for the field?

Coronary tortuosity significantly increases the risk of unplanned revascularization in patients with spontaneous coronary artery disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

LCLevent CeylanHitit Üniversitesi MRMehmet RumUniversity of Health Science MYMehmet YılmazUniversity of Health Science

Key Result

Coronary tortuosity significantly increased the risk of unplanned revascularization (OR 7.64) in patients with spontaneous coronary artery disease.

Study Design

Type

Cohort (n=86)

Multicenter

Structured PICO

What are the clinical and angiographic predictors of major adverse cardiac events and unplanned revascularization in patients with spontaneous coronary artery dissection?

Population

86 adults (>18 years) with spontaneous coronary artery dissection (SCAD) diagnosed during coronary angiography, mean age 50.8, 68.6% male, single-center in Turkey. Excluded: prior cardiac surgery or PCI, multivessel disease with ≥50% stenosis in non-dissected artery, and iatrogenic dissection.

Intervention

Initial management strategy (medical therapy, percutaneous coronary intervention [PCI], or coronary artery bypass grafting [CABG]) and anatomical feature assessment (lesion length, ostial involvement, tortuosity).

Comparator

Comparison between different initial management strategies (medical vs PCI vs CABG) and anatomical features (e.g., diffuse vs spot lesions, ostial vs non-ostial).

Outcome

Composite of major adverse cardiac events (MACE) defined as acute myocardial infarction, revascularization (PCI or CABG), congestive heart failure, or cardiac death, and Unplanned Revascularization during follow-up.composite

In patients with SCAD, ostial involvement and lower ejection fraction predict early MACE, while initial medical therapy and specific anatomical features like spot lesions and tortuosity are associated with a higher need for unplanned revascularization.

Main Result

Effect estimate: OR 7.64 (95% CI 1.84-31.62)

p-value: p=0.006

Limitations

Small sample size due to the rarity of the condition
Retrospective, single-center design introducing potential selection bias
Lack of advanced imaging techniques such as IVUS and OCT
Some patients were lost to follow-up

Abstract

AIM: Spontaneous Coronary Artery Disease (SCAD) is a rare condition that mimics acute coronary syndrome and can lead to serious complications. This study evaluates SCAD characteristics, Major Adverse Cardiac Event (MACE) predictors, revascularization needs, and treatment outcomes. MATERIALS AND METHODS: The single cardiac center, retrospective cohort study analyzed patients diagnosed with coronary artery dissection during coronary angiography between January 2014 and December 2019. RESULTS: Of 86 patients, 24(27.9%) experienced early MACE. Diffuse dissections (62.5% vs. 37.5%, p = 0.027) and ostium-involving dissections (33.3% vs. 8.1%, p = 0.006) were more frequent in the MACE group. Female patients (58.3% vs. 21.0%, p = 0.001) and those with lower pre-procedural ejection fraction (EF) (44.1 ± 13.5 vs. 55.0 ± 8.8, p = 0.004) or higher neutrophil to lymphocyte ratio (NLR) (5.59 ± 3.67 vs. 3.60 ± 2.46, p = 0.005) had a higher risk. Ostium-involving dissections (OR(Odds Ratio) = 9.41, p = 0.024) and low EF (OR = 0.931, p = 0.040) were independent predictors of MACE. Initial medical treatment is associated with higher unplanned revascularization compared to percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) (p = 0.030). Coronary tortuosity (p = 0.006) and spot lesions (p = 0.005) were associated with late revascularization. CONCLUSION: High early MACE after SCAD is associated with female gender, high NLR, and low EF. Diffuse and ostium-involving dissections significantly increase the risk of MACE. Initial treatment has been shown to influence early revascularization. while coronary features like tortuosity predict long-term outcomes. CLINICAL TRIAL NUMBER: Not applicable.

Ask AI

Helpful

Bookmark

View Full Paper