Long-Term Outcome of Patients from the Auckland Region with Spontaneous Coronary Artery Dissection

Background: Spontaneous coronary artery dissection (SCAD) is an uncommon but under-recognised cause of acute coronary syndromes, most often affecting younger women. Methods: Over the last 24 years, all patients from Auckland and Northland undergoing angiography and diagnosed with SCAD were entered into a prospective registry. Patient demographic, clinical and angiographic data were collated. Follow-up coronary angiography was undertaken in a subset. Results: Between 1994 and 2018, 155 patients experienced 166 events of SCAD. The mean age at index presentation was 49.4 ± 11.1 years and 119 (76%) were female. Atherosclerotic risk factors included overweight or obesity (44%), hypertension (28%), dyslipidaemia (24%), family history of premature ischaemic heart disease (20%), and current smoking (16%). Forty-one (27%) presented with ST-elevation myocardial infarction (STEMI) while 96 (62%) presented with non-STEMI. The left anterior descending artery was the most frequently affected artery (47%). Treatment was conservative in the majority, but 19 patients underwent coronary artery stenting and four patients had coronary artery bypass grafting. All but two patients survived the index hospital admission. Thirty-nine patients (25%) had subsequent coronary imaging, 3.28 ± 3.18 years later; the majority of coronary dissections had healed. At latest follow-up, 10 patients had suffered from recurrent dissection and 11 had died. At 5 and 10 years, Kaplan-Meier survival was 96.1% and 94.2% respectively, and survival free of dissection 92.3% and 89.0%, respectively. Conclusion: SCAD should be considered in all patients, particularly younger females, presenting with an acute coronary syndrome. The long-term clinical and angiographic prognosis is generally favourable.