Management and Outcomes of Spontaneous Coronary Artery Dissection in Christchurch

Background: Spontaneous Coronary Artery Dissection (SCAD) is an uncommon presentation of acute coronary syndrome. Awareness of this condition has grown over recent years. The optimal management and prognosis remains unknown. Method: We reviewed hospital records of all patients with angiographically confirmed SCAD in Christchurch since August 2011. Results: 103 SCAD patients (86% female, median age 54) presented with NSTEMI (63%), STEMI (29%), cardiac arrest (5%), angina (2%) or stroke (1%). The commonest culprit was the LAD (44%), with left main involved in 1% and multiple vessels in 5%. Initial management was conservative in 83% and percutaneous coronary intervention (PCI) in 17%, with 67% procedural success. 83% of patients were prescribed dual-anti-platelets, including 94% of those with PCI. Beta-blockers were prescribed in 76%. Further in-hospital myocardial infarct (MI) occurred in 5% of patients with unplanned revascularization in 3% (including CABG in 2%). Over median follow-up of 1.8 years, 16% of patients had recurrent MI, including 9% with complications of the index event, and 7% recurrent SCAD in a different vessel (median 2.5 years since index presentation). There was a trend towards increased in-hospital MI, unplanned revascularisation and recurrent MI in those treated with PCI however this was not statistically significant (p-value 0.21, 0.08 and 0.47 respectively). 3 patients died, one by intracranial haemorrhage during index presentation and the others non-cardiac. Conclusion: The majority of our SCAD cohort were managed conservatively with relatively few major in-hospital adverse events. However, recurrent SCAD is not rare and further research is needed to identify those at highest risk.