- Most cases of spontaneous coronary artery dissection (SCAD) show angiographic healing with conservative treatment.
- Not all patients require repeat angiography.
- Authors include algorithm for management and repeat angiography.
- Editorial : "a ‘less-is-more’ approach must be considered as the first-choice treatment strategy for most of our patients with SCAD.”
Why this matters
- SCAD may cause up to one-third of myocardial infarctions (MIs) in women younger than age 60 years.
- Evidence of spontaneous healing comes from small, limited studies.
- 182 lesions assessed.
- Spontaneous healing seen in 86.3% of lesions (157/182 lesions).
- After 30 days, rate was 95% (152/160).
- Over median 4.7-year follow-up, a major adverse cardiac event occurred in 37.8%:
- Death, 1.3%; recurrent MI, 35.9%; revascularization, 6.4%; stroke, 1.9%.
- Presence or absence of spontaneous healing was not predictive.
- Retrospective review, women who had nonatherosclerotic SCAD and MI and were not treated with percutaneous intervention (n=156).
- They were followed prospectively and underwent repeat angiography at physician discretion.
- Outcome: evidence of angiographic healing on follow-up, measured by:
- Improved stenosis severity vs index event;
- Residual stenosis
- Thrombolysis In Myocardial Infarction flow grade 3.
- Funding: None disclosed.
- Decision to repeat angiography may have skewed healing incidence.