Spontaneous coronary artery dissection: stent it or wait for healing?

Background: Mitral annular calcification has been associated with various systemic and cardiac diseases, with a higher prevalence in women and patients over 70.A possible association between mitral annular calcification and coronary artery disease has recently been suggested.Objective: To determine the prevalence of severe coronary artery disease in younger patients with mitral annular calcification.Methods: Consecutive patients aged < 65 years with and without mitral annular calcification as detected by echocardiography were identified from a prospective clinical database.Only patients with a coronary angiogram done within one year of their qualifying echocardiogram were analysed.Severe coronary artery disease was defined as > 70% stenosis of at least one major epicardial coronary artery.Patients: 17 735 patients were screened.Of these, 6207 (35%) had mitral annular calcification and 885 (5%) were also < 65 years old; coronary angiography was done in 100 of the latter (64 men; 36 women), mainly for anginal symptoms or a positive stress test.A control group (n = 121; 88 men, 33 women) was identified from 2840 consecutive patients screened.There was no significant difference between the groups in patient characteristics, indication for angiography, or atherosclerotic risk factors.Results: Angiography showed a higher prevalence of severe coronary artery disease in patients with mitral annular calcification than in those without (88% v 68%, p = 0.0004), and a higher prevalence of left main coronary artery disease (14% v 4%, p = 0.009) and triple vessel disease (54% v 33%, p = 0.002).The positive predictive value of mitral annular calcification for finding severe coronary artery disease was 92%.Conclusions: In patients aged < 65 years, mitral annular calcification is associated with an increased prevalence of severe obstructive coronary artery disease.It may serve as a useful echocardiographic marker for the presence of obstructive coronary artery disease, especially when associated with anginal symptoms.