This abstract reports on the largest series of SCAD patients to date ever analyzed at a single medical center. It is a retrospective study of 70 former patients at Mayo Clinic, Rochester, MN. The study was presented at the American Heart Association Scientific Sessions in Orlando, Fla., on November 15, 2011, by Marysia S. Tweet, MD, at the “Unstable Angina, NSTEMI and STEMI: Prognosis and Pharmacologic Therapy-Focus on Coronary Intervention” session.

Cutting to the chase … “This descriptive single center analysis of the largest SCAD series to date reveals SCAD to affect a young, predominantly female population. Potential risk factors are identifiable in the majority. While in-hospital mortality is low, rates of long-term MACE and SCAD recurrence are notable, underscoring the need for close clinical follow up and additional research.”

So thankful to have this data to pave the way for the current SCAD research underway at Mayo: creation of a worldwide virtual registry and the DNA biobank of SCAD patients and family members.

Core 7. Vascular Disease: Biology and Clinical Science

Session Title: Unstable Angina, NSTEMI and STEMI: Prognosis and Pharmacologic Therapy-Focus on Coronary Intervention

Abstract 14504: Outcomes After Spontaneous Coronary Artery Dissection: A Long-Term Single Center Experience

Marysia S Tweet1; Sharonne N Hayes2; Sridevi R Pitta3; Sherezade Khambatta1; Patricia J Best2; Ryan J Lennon4; Charanjit S Rihal2; Rajiv Gulati2

1 Internal Medicine, Mayo Clinic, Rochester, MN
2 Dept of Internal Medicine, Div of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
3 Cardiovascular Diseases, Schnitzler Cardiovascular Consultants, PLLC, San Antonio, TX
4 Div of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN

Background: Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic acute coronary event of uncertain etiology. Demographics, optimal treatment modalities and outcomes remain poorly understood.

Methods: A retrospective single-center study was performed to identify consecutive patients with angiographically confirmed SCAD between 1979 and 2010. Demographics, treatment modalities, in-hospital and long term outcomes were evaluated.

Results: Seventy patients with SCAD were identified with a mean age of 43.8 + 11.6 years. Fifty-four (77%) were women of whom 11 (20%) were postpartum and 10 (19%) were taking hormonal therapies. Other associated features included connective tissue disorders in 10 (14%) and extreme physical exertion in 12 (17%). There were no etiologic factors in 26 (37%). Clinical presentation was STEMI (50%), NSTEMI (40%) or symptoms without ECG changes (10%). Notably, 10 patients (14%) experienced life-threatening ventricular arrhythmias during initial presentation, and 16 (23%) presented with multivessel SCAD. Initial management strategy was conservative (39%), percutaneous coronary intervention (PCI, 40%), fibrinolysis (19%) and coronary artery bypass grafting (3%). There were no in-hospital deaths in those treated with an initial non-invasive strategy. However, of those who underwent initial PCI, the procedure was technically unsuccessful in 8/28 (29%) with 1 in-hospital death. Long-term follow up (median 44 months, IQR 17, 106) revealed recurrence of SCAD in 10.4%, death in 4.5% and heart failure in 4.9% at 5 years. The 10-year major adverse cardiac event rate (MACE) was 44.9% (death 8.5%, heart failure 11.2%, myocardial infarction 33.5% and SCAD recurrence 26%).

Conclusion: This descriptive single center analysis of the largest SCAD series to date reveals SCAD to affect a young, predominantly female population. Potential risk factors are identifiable in the majority. While in-hospital mortality is low, rates of long-term MACE and SCAD recurrence are notable, underscoring the need for close clinical follow up and additional research.

Author Disclosures: M.S. Tweet: None. S.N. Hayes: None. S.R. Pitta: None. S. Khambatta: None. P.J. Best: None. R.J. Lennon: None. C.S. Rihal: None. R. Gulati: None.

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