Patients with spontaneous coronary artery dissection experienced a 1-year mortality of 2.4%, significantly lower than 8.8% in those without SCAD, indicating lower mortality associated with SCAD.
Cohort (n=26,598)
Yes
Does spontaneous coronary artery dissection (SCAD) have different long-term mortality compared to non-SCAD acute myocardial infarction, and what factors are associated with recurrent SCAD?
Patients with SCAD have favorable survival driven primarily by their younger age and fewer comorbidities, but face a persistent long-term risk of recurrence, particularly those with fibromuscular dysplasia or migraines.
Effect estimate: HR 0.27 (95% CI 0.14-0.51)
Absolute Event Rate: 2.4% vs 8.8%
p-value: p=<0.001
Background The goal of this study is to report the characteristics and long‐term clinical outcomes of patients with spontaneous coronary artery dissection (SCAD) and to identify factors associated with recurrent SCAD . Methods and Results This is a retrospective cohort study that included patients who underwent coronary angiography for evaluation of acute myocardial infarction between 2006 and 2016. Among 26 598 patients hospitalized with a principal diagnosis of acute myocardial infarction, 208 (0.78%) were diagnosed with SCAD . Patients with SCAD were younger (49.0±11.6 versus 65.6±12.2 years) and more likely to be women (88.9% versus 31.6%). Atherosclerotic risk factors, such as hypertension, hyperlipidemia, obesity, and diabetes mellitus, were less prevalent. Median follow‐up was 4.7 years. Mortality was lower in patients with SCAD (1‐year mortality: 2.4% versus 8.8%; P <0.001). After using propensity score matching to control for differences in age, sex, and comorbidities, the difference in mortality was no longer present, suggesting that lower mortality in patients with SCAD is attributed primarily to their baseline characteristics. Recurrent SCAD occurred in 22 patients (10.6%). Multivariate Cox regression modeling showed concomitant fibromuscular dysplasia (hazard ratio, 5.1; 95% CI , 1.6–15.8; P =0.005) and migraine headaches (hazard ratio, 3.4; 95% CI , 1.4–8.4; P =0.008) to be associated with increased risk of recurrent SCAD . Conclusions Among patients with acute myocardial infarction, patients with SCAD have a lower risk of mortality, which is attributed primarily to their younger age, female sex, and low prevalence of atherosclerotic risk factors. Risk of recurrent SCAD persists years after the initial presentation. Patients with fibromuscular dysplasia and migraine are at higher risk for recurrent SCAD .
Clare et al. (Tue,) conducted a cohort in Spontaneous Coronary Artery Dissection (SCAD) (n=26,598). null vs. Patients without SCAD was evaluated on 1-year mortality (HR 0.27, 95% CI 0.14-0.51, p=<0.001). Patients with spontaneous coronary artery dissection experienced a 1-year mortality of 2.4%, significantly lower than 8.8% in those without SCAD, indicating lower mortality associated with SCAD.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: