In patients with spontaneous coronary artery dissection, predominantly managed conservatively, cardiovascular events occurred in 13% and mortality was 6.5% over a median follow-up of 5.98 years.
Observational (n=77)
No
In patients with spontaneous coronary artery dissection, conservative management is common, but medium-term cardiovascular events (13%) and mortality (6.5%) remain clinically significant.
Abstract Introduction and objectives Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome, yet its optimal management remains unstandardized. Understanding its clinical characteristics and course is essential to improve the treatment and prognosis of these patients. Methods A single-center, retrospective, observational study of 77 patients with SCAD diagnosed by coronary angiography between July 2007 and March 2025. Clinical characteristics, presentation, treatment at discharge, and follow-up for cardiovascular events and mortality were analyzed. Results The mean age was 53.9 years (SD: 13.3), and 80.5% were women. 41.6% had hypertension, 10.4% had diabetes mellitus, 29.9% had dyslipidemia, and 48% were smokers. A total of 20.8% had a history of anxiety-depressive disorder, and 19.5% had hypothyroidism. 3.9% were receiving prior hormonal treatment, and no active pregnancies were recorded at the time of the event. Regarding clinical symptoms, 40% presented as ST-segment elevation myocardial infarction. No clear trigger was identified in 61%; exercise in 16% and emotional stress in 12%. The most common culprit artery was the left anterior descending artery (42%). Left ventricular systolic function was preserved (mean LVEF 57%, SD 9.7%). Regarding treatment, 69% received a conservative approach, without coronary revascularization. At discharge, 90.9% received aspirin (ASA) and 71.4% received dual antiplatelet therapy (clopidogrel 51.9%, ticagrelor 14.3%, prasugrel 5.2%). Beta-blockers were prescribed in 84.4%. During follow-up (median 5.98 years), cardiovascular events were recorded in 13% (2 recurrences, 5 atherosclerotic ischemic events, 1 episode of heart failure, 1 arrhythmic event, and 1 cerebrovascular event). The median time to the first cardiovascular event was 4.5 years. Mortality was 6.5%, with 3 deaths from cardiovascular causes and a median time to death of 4.1 years. Conclusions SCAD commonly occurs in women without traditional risk factors. Conservative management predominates, with discharge treatment including beta-blockers and dual antiplatelet therapy. Cardiovascular events and medium-term mortality are not negligible in this group of patients.FIGURE 1
Lujan et al. (Fri,) conducted a observational in Spontaneous coronary artery dissection (SCAD) (n=77). Conservative management was evaluated on Cardiovascular events. In patients with spontaneous coronary artery dissection, predominantly managed conservatively, cardiovascular events occurred in 13% and mortality was 6.5% over a median follow-up of 5.98 years.
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