Introduction:
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of ACS that preferentially impacts young women. Increasing evidence suggests that patients with SCAD do well with a conservative approach, as intramural hematoma frequently resolves with medical management and complications from PCI are common. Our objective is to describe changes in management of SCAD over time at the University of Pennsylvania Health System (UPHS).
Methods:
We conducted a retrospective cohort study among patients treated within UPHS from 2005-2019. We identified all patients in the electronic health record with SCAD using ICD-9 (414.12) and ICD-10 (I25.42) codes. Charts were manually reviewed and indexed by date of SCAD event. Time categories were calculated by tertiles of patients. Since the first tertile spanned 21 years, this category was subdivided. The most recent time period represents practice after the AHA Scientific Statement on SCAD was published. Cochran-Armitage trend tests compared trends over time.
Results:
We identified 140 patients with SCAD. In this cohort, 43% of patients treated from 1993-2005 were managed conservatively, compared to 89% of patients treated in 2018-2019, while 57% of patients treated from 1993-2005 were managed invasively, compared to 11% of patients treated in 2018-2019, p<0.001 for trend over time (Figure). Between 1993-2005 and 2018-2019, the use of DAPT increased from 40% to 80% (p<0.001 for trend) and use of statins increased from 60% to 85% (p=0.021 for trend). Beta blocker use remained stable (80% vs. 89%, p=0.401) and ACEi/ARB use varied considerably without a clear trend over time (p=0.553).
Conclusions:
The proportion of patients with SCAD managed conservatively has steadily increased since 2015. This trend corresponds to the increased understanding of clinical outcomes of this patient population. Medical treatment has changed over time and most patients are treated with DAPT, statins, and beta blockers.
Detection of Intramural Hematoma and Serial Non-Contrast T1-Weighted Magnetic Resonance Imaging Findings in a Female Patient With Spontaneous Coronary Artery Dissection
