Clinical outcomes in spontaneous coronary artery dissection
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The Spanish Registry on SCAD (SR-SCAD) included patients from 34 hospitals. All coronary angiograms were analyzed by two experts. Those cases with doubts regarding the diagnosis of SCAD were excluded. The angiographic SCAD classification by Saw et al was followed. Major adverse cardiovascular and cerebrovascular event (MACCE) was predefined as composite of death, myocardial infarction, unplanned revascularization, SCAD recurrence or stroke. All events were assigned by a Clinical Events Committee.

After corelab evaluation, 389 patients were included. Most patients were women (88%); median age 53 years (IQR 47–60). Most patients presented as non-ST-segment-elevation myocardial infarction (54%). A type 2 intramural hematoma (IMH) was the most frequent angiographic pattern (61%). A conservative initial management was selected in 78% of patients. At a median time of follow-up of 29 months (IQR 17–38), 46 patients (13%) presented MACCE, mainly driven by reinfarctions (7.6%) and unplanned revascularizations (6.2%). Previous history of hypothyroidism (HR 3.79; p<0.001), proximal vessel involvement (HR 2.69; p=0.009), type 2 IMH (HR 2.12; p=0.037) and dual antiplatelet therapy (DAPT) at discharge (HR 2.18; p=0.042) were independent predictors of MACCE.

In this large prospective cohort of patients with SCAD, prognosis was overall favorable, with events mainly driven by reinfarctions or unplanned revascularizations. History of hypothyroidism, proximal vessel involvement, type 2 IMH and DAPT at discharge were associated with MACCE.