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Spontaneous Angiographic Healing With SCAD
Study Questions:
What are the angiographic characteristics of the dissected segments in a large cohort of spontaneous coronary artery dissection (SCAD) patients who had subsequent repeat coronary angiography?
Methods:
The study investigators included patients with nonatherosclerotic SCAD followed prospectively at Vancouver General Hospital, who underwent repeat angiography. They excluded those who had percutaneous coronary intervention for SCAD. Baseline patient demographics as well as in-hospital and long-term cardiovascular events were recorded. Angiographic characteristics of the SCAD artery at index and repeat angiograms were assessed by two experienced angiographers. Criteria for angiographic healing required all of the following: 1) improvement of stenosis severity from index event, 2) residual stenosis <50%, and 3) TIMI (Thrombolysis In Myocardial Infarction) flow grade 3.
Results:
A total of 156 patients with 182 noncontiguous SCAD lesions were included. The mean age was 51.5 ± 8.7 years, 88.5% were female, 83.3% were Caucasian, and 75.6% had fibromuscular dysplasia. All patients presented with MI. At index angiography, type 2 SCAD was most commonly observed in 126/182 (69.2%), TIMI-flow <3 was present in 85/182 (46.7%), and median lesion stenosis was 79.0% (interquartile range [IQR], 56.0-100%). Median time to repeat angiography was 154 days (IQR, 70-604 days), with median residual lesion stenosis improving to 25.5% (IQR, 12.0-38.8 days), and TIMI-flow <3 observed in 10/182 (5.5%). Angiographic healing occurred in 157/182 (86.3%). Of repeat angiography performed ≥30 days post-SCAD, 152/160 (95%) showed spontaneous angiographic healing.
Conclusions:
The authors concluded that the majority of coronary arteries affected by SCAD heal spontaneously on repeat angiography.
Perspective:
This study reports that the majority of SCAD lesions treated conservatively heal spontaneously. Furthermore, there appears to be a time-dependency to angiographic healing, where 95% of SCAD lesions were healed when angiography was performed ≥30 days after the acute SCAD event. These results are quite reassuring and support the current recommendation for conservative therapy for low-risk patients with SCAD, i.e., in the absence of hemodynamic instability, ongoing ischemia, or critical anatomy (left main dissection, or multivessel proximal dissections). Additional studies are indicated to better understand why a small proportion of SCAD lesions do not heal spontaneously and if such individuals can be prospectively identified.
Keywords: Acute Coronary Syndrome, Constriction, Pathologic, Coronary Angiography, Coronary Vessel Anomalies, Dissection, Fibromuscular Dysplasia, Hemodynamics, Myocardial Infarction, Percutaneous Coronary Intervention, Secondary Prevention, Vascular Diseases
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