Experimental Biology 2010: Spontaneous Coronary Artery Dissection: Aggressive Or Conservative Management?

Purpose of Study: Spontaneous coronary artery dissection (SCAD) is a rare condition that commonly presents as an acute coronary event in younger population, especially in female of childbearing age. At present there is no consensus on etiology, prognosis, and treatment of SCAD. The purpose of this study is an attempt to compare the effectiveness of various treatment modalities on the outcome of SCAD

Methods Used: Medline database was searched for Spontaneous coronary artery dissection between 1931 and 2008. A total of 440 cases of SCAD were identified. Demographic data was analyzed with either student’s t-test or chi-square test for categorical and nominal variables respectively. Kaplan-Meier outcome analysis was used to assess the outcome of a given treatment for all patients after 1990.

Summary of Results: SCAD was found more commonly in females with 307 (69.8%) cases. Pregnancy was associated with SCAD in 80 (18.2%) cases. Among pregnant, 67 (83.6%) patients developed SCAD in the postpartum period and 13 (16.4%) patients in the prepartum period. Analysis of treatment modalities showed that 21.2% of the patients who were conservatively managed after the initial diagnosis, eventually required surgical or catheter-based intervention compared to 2.5% of patients, who were initially treated with aggressive strategy. Kaplan-Meier outcome analysis showed that patients with isolated single lesion in left or right coronaries had a statistically significant better outcome when treated with an early aggressive strategy, including CABG or stent placement as compared to conservative strategy (P value < 0.023, P value < 0.006 respectively).

Conclusions: Early intervention with either CABG or PCI following diagnosis of SCAD may leads to a better outcome and less need for further intervention.