Spontaneous coronary dissection. First nationwide report

Abstract

Spontaneous coronary dissection is an infrequent cause of acute coronary syndrome, particularly in middle-aged women.
We made review of the database of our center since the date of acquisition of intracoronary imaging techniques in our laboratory (July 2013 - December 2019). Coronary spontaneous dissection was found in 13 patients of 4706 diagnostic coronary angiograms (0.3%). We present angiography and coronary ultrasonography studies representative of this case series. The mean age of presentation was 52±14 years, 11 of 13 of the cases were women. The mean follow-up time was 39 ± 27 months. The most frequent clinical presentation was acute coronary syndrome without ST elevation 6/13.
The most frequently affected vessel was the anterior descending artery (n= 8). In all cases, troponins above the 99 percent were found. Conservative treatment was performed in 11 cases and successful angioplasty in the other two cases.
One patient under conservative treatment died during hospitalization. The use of intracoronary imaging was required in 9 of the 13 cases. In conclusion, we present for the first time, a national registry of spontaneous coronary dissection describing its clinical, image, treatment and evolution characteristics.