Spontaneous coronary artery dissection natural history, complications and prognosis

Spontaneous Coronary Artery Dissection Microchapters
Home
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Spontaneous coronary artery dissection from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Approach
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Angiography
CT
MRI
Echocardiography
Other Imaging Findings
Other Diagnostic Studies
Treatment
Treatment Approach
Medical Therapy
Percutaneous Coronary Intervention
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Type 1 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Type 2A Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Type 2B Case 1 Case 2 Case 3 Case 4 Type 3 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.

Synonyms and keywords: SCAD

Overview

The natural history of spontaneous coronary artery dissection has not been well characterized. Early reports based on post-mortem examinations after sudden cardiac death suggest a dismal prognosis. However, recent studies demonstrate that most patients survive initial hospitalization and have a favorable prognosis following clinical stabilization.

Natural History, Complications and Prognosis

Natural History

The fact that the diagnosis was made so often in the past on autopsy speaks to the poor clinical outcomes that have been associated with the condition. Outcomes in the modern era of stent placement and improved antithrombins may be improved, but solid data are lacking. Based on the limited outcomes data, SCAD survivors typically have a good long-term prognosis. Majority of cases result in spontaneous healing, with improvement starting after several weeks and resolution at approximately 1-2 years. However, there is an increased risk for recurrent SCAD events as well as other major cardiovascular events.

Complications

Complications include:

• Extension of dissection(s)
• Recurrent dissection(s)
• Myocardial infarction
• Congestive heart failure
• Unstable ventricular arrhythmias
• Sudden cardiac death

Prognosis

Good prognosis is associated with:

• Small, limited dissections
• Incomplete or lesser degree of lumen obstruction

Bad prognosis is associated with:

• Left main coronary artery involvement
• Multi-vessel involvement

Long term survival after an index SCAD episode appears to be better compared with that of acute coronary syndrome. However, rates of major adverse cardiac events (MACE) resulting from index episode and complications are similar.

In the current literature, the prognosis of SCAD has been determined according to the small case series including different treatment options. According to a recent 168 patient-cohort study, in hospital MI rate was 4.5% and long term major adverse coronary events have been reported as 20%. PCI has failed in one-third of cases. In hospital prognosis was better in the conservative treatment group when compared with patients managed with percutaneous coronary intervention (PCI).