After SCAD, most coronary arteries heal spontaneously

  • Hassan S & al.
  • JACC Cardiovasc Interv
  • 22 Feb 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • Nonrandomized.
  • Decision to repeat angiography may have skewed healing incidence.

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