Background
Spontaneous coronary artery dissection (SCAD) is best managed conservatively however, a subset of patients require percutaneous coronary intervention (PCI). We assessed angiographic success, complications and major adverse cardiovascular (MACE) outcomes of PCI-managed SCAD.
Methods
Multicentre cohort study in 23 hospitals in Australia-New Zealand (2009-2024). Patients aged =>18 years with acute coronary syndrome and core-laboratory confirmed SCAD were included. PCI success was defined as residual stenosis <10%–20% post-stenting or <50% post-balloon angioplasty and achieving thrombolysis in myocardial infarction (TIMI) II/III flow. Angiographic improvement was defined as ≥1 TIMI flow increase. Kaplan–Meier curves analysed MACE for conservative versus PCI-managed SCAD.
Results
Total 552 confirmed SCAD patients were included, mean age 52.0±10.4 years, 88.6% female and 89.4% managed conservatively. Among 10.6% (n=59) PCI-managed SCAD patients (stenting 55.9%, balloon angioplasty 22.0%, wiring only 22.0%; with intravascular imaging in 15.3%), PCI success was achieved in 49.2% and angiographic improvement in 55.9%. Complications occurred in 32.2% of PCI-managed SCAD (12 cases haematoma/dissection propagation; six slow flow/no-reflow; two coronary perforation; two emergency bypass grafting [Table]); compared to 0.7% of conservatively-managed patients (catheter-induced dissection) (p<0.001). Moderate/severe coronary tortuosity was associated with lower PCI success [odds ratio 0.33, 95%confidence interval 0.1–0.96, p=0.042] with no association with SCAD type, length or vessel location (p-values>0.1). Three-year MACE was similar between conservatively and PCI-managed SCAD patients (10.6% versus 11.7%, log rank p=0.28) (Figure).
Conclusion
While most patients with SCAD were managed conservatively, when performed, PCI had a low success rate and high occurrence of complications. Despite these findings, long-term outcomes with PCI-managed SCAD were comparable to conservatively managed patients.