Spontaneous Coronary Artery Dissection: An Epidemiological and Angiographical Study From a High Volume Tertiary Care Cardiac Centre

Abstract

CONTEXT: Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause for acute coronary syndrome (ACS). Although a rare disease, due to increased awareness and early use of coronary angiography more cases are being picked up of late. Patient characteristics and management differ from those of typical ACS cases, hence recognition of SCAD is very important. AIM: To identify epidemiologic and clinical characteristics of patients with SCAD and determine outcomes. DESIGN: Data of 10002 patients who underwent coronary angiography (CAG) between 1st June 2018 and 31st May 2019 were retrospectively analysed to determine the cases of SCAD at Sri Jayadeva Institute of Cardiovascular Sciences & Research. Epidemiologic and clinical characteristics of 51 such patients with SCAD were then analysed. OUTCOME MEASURES: Clinical characteristics, predisposing factors, angiographic ndings RESULT: In 51 patients (08 women and 43 men) who were hospitalized for ACS, spontaneous dissection of coronaries was detected. The mean age for women was 49.75 years & 48.27 for men. Precipitating factors were hypertension in 14 patients (27.45%), dyslipidemia in 3 patients (5%) and smoking in 10 patients (19.60%). Diabetes was noted in 6 patients (11%). In 16 patients, the coronary angiography showed multivessel disease, while in 08 patients there were no signicant lesions in the coronary vessels. The left anterior descending (LAD) artery was the most commonly affected coronary artery (56.9%, 29 of 51 cases) followed by right coronary artery (35.3%,18 of 51 cases. Mid & distal segments were the common sites for dissection (85%, 44 of 51). CONCLUSION: SCAD was noted with similar incidence in our sample population as seen in previous studies. The incidence is more in men as opposed to other studies wherein females had a higher incidence. Risk factors like hypertension, dyslipidemia & diabetes were seen in a small percentage. LAD was the most common artery to be affected. Most patients were managed conservatively without the need for revascularization