Clinical presentation of patients with spontaneous coronary artery dissection

Catheter Cardiovasc Interv. 2017 Jun 1;89(7):1149-1154. doi: 10.1002/ccd.26977. Epub 2017 Feb 28.

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is an infrequent but important cause of myocardial infarction (MI) especially in younger women. However, the clinical presentation and the acuity of symptoms prompting invasive management in SCAD patients have not been described. Understanding these presenting features may improve SCAD diagnosis and management.

Methods: We reviewed SCAD patients who were prospectively followed at the Vancouver General Hospital SCAD Clinic. Their presenting symptoms and unstable features were obtained from detailed clinical histories and hospital admission documentation. Baseline characteristics, predisposing and precipitating conditions, angiographic findings, management strategies, in-hospital, and long-term events were recorded prospectively.

Results: We included 196 SCAD patients who had complete documentation of their presenting symptoms. The majority were women (178/196; 90.8%) and all presented with MI (24.0% STEMI). The most frequent presenting symptom was chest discomfort, reported by 96%. Other symptoms included arm pain (49.5%), neck pain (22.1%), nausea or vomiting (23.4%), diaphoresis (20.9%), dyspnea (19.3%), and back pain (12.2%). Ventricular tachycardia/fibrillation occurred in 8.1% (16/196), with 1.0% having cardiac arrest. The time from symptom onset to hospital presentation was 1.1 ± 3.0 days. NSTEMI patients had longer delay for coronary angiography compared with STEMI (2.0 ± 2.5 days vs. 0.8 ± 1.7 days, P = 0.002). Overall, 34.2% had unstable symptoms upon arrival for coronary angiography. Those with unstable symptoms were more likely to undergo repeat angiography (65.7% vs. 50.4%, P = 0.049), and repeat or unplanned revascularization (14.9% vs. 5.4%, P = 0.033) during acute hospitalization.

Conclusion: Chest discomfort was the most frequent presenting symptom with SCAD and one-third had unstable symptoms prompting urgent invasive angiography. © 2017 Wiley Periodicals, Inc.

Keywords: nonatherosclerotic coronary disease; presenting symptoms.

MeSH terms

  • Adult
  • Angina, Stable / etiology
  • Angina, Unstable / etiology
  • British Columbia
  • Coronary Angiography
  • Coronary Vessel Anomalies / complications*
  • Coronary Vessel Anomalies / diagnostic imaging
  • Coronary Vessel Anomalies / mortality
  • Coronary Vessel Anomalies / therapy
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Medical Records
  • Middle Aged
  • Myocardial Revascularization
  • Non-ST Elevated Myocardial Infarction / diagnostic imaging
  • Non-ST Elevated Myocardial Infarction / etiology*
  • Non-ST Elevated Myocardial Infarction / mortality
  • Non-ST Elevated Myocardial Infarction / therapy
  • Predictive Value of Tests
  • Prospective Studies
  • Retrospective Studies
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / etiology*
  • ST Elevation Myocardial Infarction / mortality
  • ST Elevation Myocardial Infarction / therapy
  • Time Factors
  • Treatment Outcome
  • Vascular Diseases / complications
  • Vascular Diseases / congenital*
  • Vascular Diseases / diagnostic imaging
  • Vascular Diseases / mortality
  • Vascular Diseases / therapy

Supplementary concepts

  • Coronary Artery Dissection, Spontaneous