Dr. Ahmed Mohamed Ramzy Ahmed :: Publications:

Aims: Spontaneous coronary artery dissection is an unusual cause of acute coronary syndrome. Although the prognosis is good the management is not well established. In this series we describe the clinical presentation, management and long term outcomes of a retrospective cohort that presented with spontaneous coronary dissection. Methods and results: The definition of spontaneous coronary artery dissection was based on the presence of medial dissection or intra-mural haematoma that was recognised by angiography and according with the classification proposed by Saw and all. 38 patients diagnosed as spontaneous coronary artery dissection in our institution from 2000 to 2014 were retrospectively studied (male/female 16/22, age 54±12 [SD] years). The clinical presentation was myocardial infarction in 86.8% of patients. Spontaneous coronary artery dissection was developed after physical or emotional stress in 4 patients (10%) and 7 patients (20%) had hypothyroidism. The left anterior descending artery was involved in 22 patients (60.5%) and left main was involved in 2 patients. 5 patients had multi-vessel SCAD (13.5%). Recurrences of spontaneous coronary artery dissection were shown in 3 patients (7.9%). According to the classification proposed by Saw 21 patients (55.3%) had type 1 dissection (evident arterial wall stain), 11 patients (28.9%) had type 2 (diffuse stenosis of varying severity) and 6 of them (15.8%) had type 3 (mimic atherosclerosis) dissection. Coronary artery tortuosity was present in 17 patients (45%) and it is significantly related with major adverse cardiac events (p=0.001) and complications during PCI (p=0.001). The management of spontaneous coronary artery dissection was revascularisation of the culprit lesion in 68.4% of patients (25 - PCI, 1-CABG) with in-hospital death of 8% (3 patients: 2 cases which the dissection progressed retrogradely during PCI and involved the left main and complicated by cardiogenic shock and 1 case involving also the aortic root). 21.6% of cases were initially treated with fibrinolysis which was also significantly related with major adverse cardiac events (p