Spontaneous Coronary Artery Dissection: Report on 20 Cases at Multiple Centers and a Review of the Literature

Spontaneous coronary artery dissection (SCAD) is an uncommon etiology of Acute Coronary Syndrome (ACS); however, appropriate treatment based on early diagnosis can improve outcomes. We screened medical records of all ACS patients who were admitted to one of 8 different centers (Cardiovascular Research Consortium-8 Universities) and underwent emergent coronary angiography from January 2001 to December 2014. From these ACS patients, we selected the patients with SCAD based on a review of the results of coronary angiography. Patient demographics, treatment, and in-hospital and long-term outcomes were determined from a review of medical records and angiographic findings. Of the 9377 ACS patients, 20 (0.21%) were diagnosed with SCAD. In these 20 SCAD patients, the mean age was 48.6 ± 12.0 years old, and 19 patients were female (95.0%). In 3 patients (15%), SCAD was associated with pregnancy. Coronary spasm was associated with SCAD in 2 patients (10%). Two patients (10%) were treated conservatively, and percutaneous coronary intervention was performed in 18 patients (90%). Two patients (10.0%) received target lesion revascularization, and one patient (5%) received coronary artery bypass grafting (CABG). SCAD recurred in one patient (5%), and there was in-hospital death in one patient (5%) after CABG. The patient demographics and outcomes in this study were compatible with recent reports of SCAD, except for the trigger of coronary spasm. SCAD should be suspected in middle-aged female ACS patients, and conservative treatment is recommended when there is no ongoing ischemia or left main trunk dissection. In addition, close follow-up is important.