A study has found that a majority of coronary arteries that undergo spontaneous coronary artery dissection (SCAD) demonstrate spontaneous healing, and most heal 30 days after the index SCAD event. The full report from this study was published in JACC Cardiovascular Interventions.
People with non-atherosclerotic SCAD who received care at the Vancouver General Hospital were included in the retrospective study (n=156). Patients underwent repeat coronary angiography after their first SCAD event.
The researchers collected data on in-hospital and long-term cardiovascular events, and 2 investigators assessed the angiographic characteristics of the SCAD artery at admission and at each angiogram. Angiographic healing required improvements in stenosis severity from the index event, a residual stenosis of <50%, and Thrombosis In Myocardial Infarction (TIMI)-3 flow.
In the final cohort, a total of 182 non-contiguous SCAD lesions were recorded, and all patients had a myocardial infarction at baseline. Type 2 SCAD was observed in 69.2% of patients at the first imaging. Additionally, the median lesion stenosis was 79.0% and TIMI-flow <3 was recorded in 46.7% of patients.
The median residual lesions stenosis improved to 25.5% (range, 12.0-38.8), and 5.5% of patients had TIMI-flow<3 at repeat angiography. The majority of patients experienced angiographic healing (86.3%).
Approximately 95% of patients with repeat angiography ≥30 days after the index SCAD event had spontaneous healing of affected arteries.
Limitations of the study include its retrospective and observational design as well as the inclusion of mostly white and female patients.
The researchers concluded that additional “research should be done to understand why a small proportion of SCAD lesions do not heal spontaneously.”
Hassan S, Prakash R, Starovoytov A, Saw J. Natural history of spontaneous coronary artery dissection with spontaneous angiographic healing [published online February 22, 2019]. JACC Cardiovasc Interv. doi: 10.1016/j.jcin.2018.12.011