Acute Coronary Syndrome in Young Women due to Spontaneous Coronary Artery Dissection

pp 347-351

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Its prevalence is higher in young women, but its clinical characteristics and outcome remain insufficiently studied.
Objective: The aim of this study was to evaluate the baseline characteristics and outcome of SCAD compared with atherosclerotic acute coronary syndrome (AACS) in young women.
Methods: This prospective cohort study compared women <60 years admitted with ACS due to SCAD with another cohort with AACS, between 2015 and 2017.
Results: A total of 49 patients were included, 7 of which (14.29%) presented SCAD. Median follow-up was 10 months (25-75 IQR: 2-18). Median age was 44 years (25-75 IQR: 38-45) in the SCAD group and 55 years (25-75 IQR: 40-58) in the AACS group (p=0.002), with greater prevalence of hypertension and dyslipidemia (69% vs. 14.3%, p=0.006 and 71% vs. 14% p=0.004,respectively). Episodes of acute stress (57.1% vs. 4.8%, p=0.001) and use of ergotamine (28.6% vs. 0%, p=0.0001) were more common in the SCAD group, and ST-segment elevation myocardial infarction was the most frequent presentation (71.4% vs. 28.6%; p=0.02). The primary endpoint occurred in 3 patients (42.9%) of the SCAD group and was less frequent in the AACS group (9.5%, p=0.02). During follow-up, 14.9% of patients in the SCAD group and 14.8% in the AACS group presented the
secondary endpoint (p=0.9).
Conclusions: Women with SCAD had lower prevalence of cardiovascular risk factors and presented ACS with worse hemodynamic impact and more complications. The long-term outcome did not show significant differences.