Introduction
Spontaneous coronary artery dissection (SCAD) is previously known as a disease of young females without cardiovascular risk factors. Recent evidence has showed that SCAD can also be encountered in middle aged and even older patients with atherosclerotic risk factors. Its prevalence ranges from 0.1% to 4% in patients with ACS depending on imaging technique that is used for the diagnosis of SCAD such as optical coherence tomography or intravascular ultrasound. Herein, we present the largest data evaluating demographic, clinical and angiographic characteristics, management modalities, early and late outcomes of SCAD in Turkish patients.
Methods
We reviewed the database of the cardiac catheterisation laboratory of our institute for all coronary angiography reports between January 2011 and June 2015. Among 30255 coronary angiography reports, 30 patients with the definite diagnosis of SCAD were included into the study. All of these 30 patients had pathognomonic angiographic appearance of SCAD with contrast dye staining of the arterial wall with multiple radiolucent lumens.
Methods
We reviewed the database of the cardiac catheterisation laboratory of our institute for all coronary angiography reports between January 2011 and June 2015. Among 30255 coronary angiography reports, 30 patients with the definite diagnosis of SCAD were included into the study. All of these 30 patients had pathognomonic angiographic appearance of SCAD with contrast dye staining of the arterial wall with multiple radiolucent lumens.
Results
Mean age was 49.1 ± 11.5 years with a range between 25 to 69 years and most patients were males, constituting 18 (60%) of our sample. Out of 12 female patients, 4 patients were presented during the postpartum period with a mean maternal age of 31.7 years. Multivessel dissection was present in 3 (10%) patients. The most commonly involved artery was the RCA (45%). The left main coronary artery was spontaneously dissected in 4 (13.3%) patients. Initial TIMI flow was ≥2 in 28 (93.3%) patients. The vast majority of the patients (22 out of 30, 73.3%) presented with the spectrum of acute coronary syndrome. Sixteen patients (53.3%) had isolated SCAD and 14 (47.7%) patients had accompanying significant CAD. Conservative therapy was the initial treatment strategy in 14 (46.6%) patients. PCI was the treatment of choice in 8 (26,6%) and CABG was the treatment of choice in 8 patients (26.6%), initially. During median follow-up of 23 months, none of our patients has died. 7 (23.3%) patients developed dilated cardiomyopathy during follow-up. Long-term MACE, namely reinfarction and target vessel revascularization, was observed in only 2 patients (6.6%).
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