Author + information
- Received March 13, 2012
- Revision received May 15, 2012
- Accepted June 7, 2012
- Published online October 1, 2012.
- Fernando Alfonso, MD, PhD⁎ (, )
- Manuel Paulo, MD,
- Vera Lennie, MD,
- Jaime Dutary, MD,
- Esther Bernardo, MB,
- Pilar Jiménez-Quevedo, MD, PhD,
- Nieves Gonzalo, MD, PhD,
- Javier Escaned, MD, PhD,
- Camino Bañuelos, MD,
- María J. Pérez-Vizcayno, MD,
- Rosana Hernández, MD, PhD and
- Carlos Macaya, MD, PhD
- ↵⁎Reprint requests and correspondence:
Dr. Fernando Alfonso, Interventional Cardiology, Cardiovascular Institute, Clínico San Carlos University Hospital, IdISSC, Ciudad Universitaria, Plaza de Cristo Rey, Madrid 28040, Spain
Objectives This study sought to assess the long-term clinical outcome of patients with spontaneous coronary artery dissection (SCD) managed with a conservative strategy.
Background SCD is a rare, but challenging, clinical entity.
Methods A prospective protocol, including a conservative management strategy, was followed. Revascularization was only considered in cases with ongoing/recurrent ischemia. Inflammatory/immunologic markers were systematically obtained.
Results Forty-five consecutive patients (incidence 0.27%) were studied during a 6-year period. Of these, 27 patients (60%) had “isolated” SCD (I-SCD), and 18 had SCD associated with coronary artery disease (A-SCD). Age was 53 ± 11 years, and 26 patients were female. Most patients presented with an acute myocardial infarction. SCD had a diffuse angiographic pattern (length: 31 ± 23 mm). In 11 patients, the diagnosis was confirmed by intracoronary imaging techniques. Sixteen patients (35%) required revascularization during initial admission. One patient died after surgery, but no additional patient experienced recurrent myocardial infarction. No significant inflammatory/immunologic abnormalities were detected. At follow-up (median 730 days), only 3 patients presented with adverse events (1 died of congestive heart failure, and 2 required revascularization). No patient experienced a myocardial infarction or died suddenly. Event-free survival was similar (94% and 88%, respectively) in patients with I-SCD and A-SCD. Notably, at angiographic follow-up, spontaneous “disappearance” of the SCD image was found in 7 of 13 (54%) patients.
Conclusions In this large prospective series of consecutive patients with SCD, a “conservative” therapeutic strategy provided excellent long-term prognosis. Clinical outcome was similar in patients with I-SCD and A-SCD. The natural history of SCD includes spontaneous healing with complete resolution.
- myocardial infarction
- optical coherence tomography
- spontaneous coronary artery dissection
The authors have stated that they have no relationships relevant to the contents of this paper to disclose.
- Received March 13, 2012.
- Revision received May 15, 2012.
- Accepted June 7, 2012.
- American College of Cardiology Foundation