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

Hidehiko Nakamura, Isao Taguchi, Shiro Nakahara, Shu Inami, Masashi Sakuma, Hiroyuki Sugimura, Kazuo Matsumoto, Tomonori Itoh, Yoshihiro Morino, Tomohiro Mizutani, Junya Ako, Masataka Nakano, Koichiro Yoshioka, Takanobu Mitarai, Yoshihiro Akashi, Takahiro Nomura, Hideaki Yoshino and Cardiovascular Research Consortium-8 Universities (CIRC-8U)

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.