Clinical characteristics, medication, and outcomes of spontaneous coronary artery dissection patients with an initial strategy of percutaneous coronary intervention or conservative therapy.

objectivesSpontaneous Coronary Artery Dissection (SCAD) is a rare non-obstructive acute coronary syndrome. Although previously characterized by a lack of consensus on optimal management, treatment guidelines for SCAD have now been established to inform clinical practice. However, long-term follow-up data specifically for SCAD patients in China are lacking. The present study aimed to assess the clinical and angiographic outcomes of a Chinese cohort managed with initial Percutaneous Coronary Intervention (PCI) or conservative therapy.

methodsThe study enrolled 33 patients from the Northern Jiangsu People's Hospital, affiliated with Yangzhou University, whose initial diagnosis of SCAD was made from April 1, 2014 to June 30, 2020. The study recommended a follow-up coronary angiography for all patients 6 months after the initial onset. Clinical characteristics, angiographic findings, initial treatment strategies, discharge medications, and outcomes were recorded for all patients.

resultsAmong the 33 patients with SCAD (mean age 51.9±9.7 years, 69.7% female), myocardial infarction was the predominant presentation (75.7%), with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) accounting for the majority of cases (51.5%). The left anterior descending artery (LAD) was the most frequently involved vessel (63.6%). According to the Saw classification, type 2b lesions predominated (65.7%). Compared to the conservative group, patients in the PCI group presented with a significantly higher degree of stenosis [100% (IQR, 98-100) vs. 70% (IQR, 70-80), P < 0.001] and a higher prevalence of baseline TIMI 0-1 flow (81.8% vs. 0%, P < 0.001). PCI was technically successful (TIMI 2-3 flow post-procedure) in all patients. During the initial hospitalization, the overall MACE rate was 9.1% (3/33). Over a median follow-up of 27.5 months (IQR, 15.3-51.3), the MACE rate was 9.4% (3/32), including one cardiac death. Recurrent Spontaneous Coronary Artery Dissection (R-SCAD) was confirmed in 3 patients (9.4%). No significant difference was observed in MACE-free survival between the PCI and conservative groups (59.3% vs. 85.7%, P=0.126). Follow-up coronary angiography (CAG) performed in 16 patients (50%) demonstrated angiographic healing in 15 patients (93.8%). Notably, 2 of the 3 patients who experienced late MACE had previously demonstrated complete lesion healing on 6-month follow-up CAG. Patients who underwent 6-month follow-up CAG exhibited a numerically lower MACE-free survival rate compared to those who did not, although this difference did not reach statistical significance (62.9% vs. 100.0%, P=0.10).

conclusionThis study reported that the outcomes of patients subjected to an initial conservative strategy were not inferior as compared to those treated with PCI. In patients who underwent follow-up CAG, healing was commonly observed. Therefore, guiding antiplatelet therapy based on angiographic findings and comorbidities appears rational.