Spontaneous coronary artery dissection: Ten years? experience of a tertiary center

Introduction: Spontaneous coronary artery dissection (SCAD) represents 1-4% of all acute coro-nary syndromes (ACS), and is a particularly important cause among young women and individuals with few cardiovascular risk factors.Objectives: To characterize clinical background, therapeutic management and clinical out-comes in a SCAD population.Methods: We retrospectively analyzed all consecutive patients diagnosed with SCAD at a ter-tiary center between August 2009 and May 2020, with a median follow-up of 40 months (IQR 14-95 months). SCAD was classified according to the Saw angiographic SCAD classification.Results: A total of 36 patients were included, 94% female, mean age 51 years (+/- 11 years). A trigger was only detected in 8% and associated conditions in 31% of patients, mainly inflamma-tory or autoimmune systemic diseases and migraine. Most patients had non-ST-elevation ACS and 33% presented with ST-elevation ACS. The most frequent culprit lesion was the left ante-rior descending (LAD) artery (67%); mid to distal segments were the most affected (94%) and type 2 dissection the most prevalent (60%). Almost all patients were successfully medically man-aged, with only four undergoing percutaneous intervention. During follow-up, ischemic events recurred in 15% of patients and no patient died. Patients with type 2 dissection exhibited lower risk of recurrence compared to type 1 (p=0.049, OR=0.13).Conclusion: SCAD patients were mainly young or middle-aged women; the LAD artery was the most affected vessel and type 2 dissection the most prevalent. This report showed for the first time a correlation between type 2 SCAD and lower risk of recurrence.(c) 2023 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espan similar to a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).