In patients with SCAD, MACCE occurred in 13% over 29 months; hypothyroidism (HR 3.79), proximal vessel involvement, type 2 IMH, and DAPT at discharge were independent predictors of MACCE.
Cohort (n=389)
Yes
In a large prospective cohort of SCAD patients, prognosis was generally favorable, though hypothyroidism, proximal vessel involvement, type 2 IMH, and DAPT at discharge were associated with increased risk of MACCE.
OBJECTIVE: Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome. Our aim was to assess adverse events at follow-up from a nationwide prospective cohort. METHODS: was followed. Major adverse cardiovascular and cerebrovascular event (MACCE) was predefined as composite of death, myocardial infarction, unplanned revascularisation, SCAD recurrence or stroke. All events were assigned by a Clinical Events Committee. RESULTS: After corelab evaluation, 389 patients were included. Most patients were women (88%); median age 53 years (IQR 47-60). Most patients presented as non-ST-segment-elevation myocardial infarction (54%). A type 2 intramural haematoma (IMH) was the most frequent angiographic pattern (61%). A conservative initial management was selected in 78% of patients. At a median time of follow-up of 29 months (IQR 17-38), 46 patients (13%) presented MACCE, mainly driven by reinfarctions (7.6%) and unplanned revascularisations (6.2%). Previous history of hypothyroidism (HR 3.79; p<0.001), proximal vessel involvement (HR 2.69; p=0.009), type 2 IMH (HR 2.12; p=0.037) and dual antiplatelet therapy (DAPT) at discharge (HR 2.18; p=0.042) were independent predictors of MACCE. CONCLUSIONS: In this large prospective cohort of patients with SCAD, prognosis was overall favourable, with events mainly driven by reinfarctions or unplanned revascularisations. History of hypothyroidism, proximal vessel involvement, type 2 IMH and DAPT at discharge were associated with MACCE. TRIAL REGISTRATION NUMBER: NCT03607981.
García-Guimarães et al. (Mon,) conducted a cohort in Spontaneous coronary artery dissection (SCAD) (n=389). Risk factors (hypothyroidism, proximal vessel involvement, type 2 IMH, DAPT) vs. Absence of risk factors was evaluated on Major adverse cardiovascular and cerebrovascular event (MACCE). In patients with SCAD, MACCE occurred in 13% over 29 months; hypothyroidism (HR 3.79), proximal vessel involvement, type 2 IMH, and DAPT at discharge were independent predictors of MACCE.
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