Author + information
- Received July 10, 2012
- Revision received August 20, 2012
- Accepted August 22, 2012
- Published online January 1, 2013.
- Jacqueline Saw, MD⁎,⁎ (, )
- Donald Ricci, MD⁎,
- Andrew Starovoytov, MD⁎,
- Rebecca Fox, MSc⁎ and
- Christopher E. Buller, MD†
- ↵⁎Reprint requests and correspondence
: Dr. Jacqueline Saw, Vancouver General Hospital, 2775 Laurel Street, 9th Floor, Vancouver, British Columbia, V5Z 1M9, Canada
Objectives We sought to evaluate the prevalence of fibromuscular dysplasia (FMD) and other predisposing conditions among spontaneous coronary artery dissection (SCAD) patients.
Background Spontaneous coronary artery dissection is considered rare. However, we observed many young women with SCAD and concomitant FMD.
Methods Spontaneous coronary artery dissection patients were identified prospectively and retrospectively at Vancouver General Hospital over the past 6 years. Coronary angiograms were meticulously reviewed by 2 senior interventional cardiologists. Identified patients were contacted for prospective evaluation at our SCAD clinic, and screening for FMD of renal, iliac, and cerebrovascular arteries was performed with computed tomography angiography or magnetic resonance angiography, if not already screened during the index angiogram. Potential predisposing and precipitating conditions for SCAD were extracted from clinical history.
Results We identified 50 patients with nonatherosclerotic SCAD from April 2006 to March 2012. Average age was 51.0 years, and almost all were women (98.0%). All presented with myocardial infarction (MI), 30.0% had ST-segment elevation, and 70.0% had non–ST-segment elevation MI. Only 1 was postpartum, and 2 were involved in intense isometric exercises. Emotional stress was reported in 26.0% before the MI. Twelve percent had >1 dissected coronary artery. Most SCAD patients had FMD of ≥1 noncoronary territory (86.0%): 25 of 43 (58.1%) renal, 21 of 43 (48.8%) iliac, and 20 of 43 (46.5%) cerebrovascular (6 of 43, 14.0% had intracranial aneurysm). Five had incomplete FMD screening.
Conclusions Nonatherosclerotic SCAD predominantly affects women, and most have concomitant FMD. We suspect these patients have underlying coronary FMD that predisposed them to SCAD, but this requires proof from histology or intracoronary imaging of the affected coronary arteries.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 10, 2012.
- Revision received August 20, 2012.
- Accepted August 22, 2012.
- American College of Cardiology Foundation