Characteristics of patients found to have spontaneous coronary artery dissection at coronary angiography

OBJECTIVES
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary artery syndromes and sudden death. We evaluated characteristics of patients who were found to have SCAD at coronary angiography.

STUDY DESIGN
We reviewed 32,000 coronary angiographies performed in a five-year duration and detected SCAD in 24 patients (0.07%; 22 males, 2 females; mean age 54 years; range 35 to 72 years). Clinical and angiographic findings of these patients were evaluated.

RESULTS
Of 24 patients with SCAD, eight patients (33.3%) had no coronary artery disease (CAD), whereas 16 patients (66.7%) had CAD of varying severity. Two or more risk factors were detected in 66.7% and 33.3% of patients with or without CAD, respectively. Dissections were found in the left coronary artery in 17 cases (70.8%), left anterior descending artery in four cases (16.7%), and circumflex artery in three cases (12.5%). Fourteen patients had no restriction in flow, so they received medications including aspirin, nitroglycerin, beta-blocker, ACE inhibitor, and a statin. Five patients underwent emergency coronary bypass surgery, four patients underwent primary stenting, and one patient received thrombolytic treatment. No complications were encountered during hospitalization.

CONCLUSION
Detection of CAD of varying severity or multiple cardiovascular risk factors in most of the patients may imply the need for considering coronary atherosclerosis among classical risk factors for SCAD.