A contemporary look into spontaneous coronary artery dissection: the SwissSCAD registry
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Background
Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of acute coronary syndrome. Data regarding contemporary treatment outcomes remain limited, providing the rationale for the establishment of the SwissSCAD registry.
Objectives
The primary objective of the SwissSCAD registry, described in this manuscript, is to address contemporary characteristics, management and in-hospital major adverse cardiac events (MACE; defined as a composite of stroke/transient ischemic attack, reinfarction, repeat revascularization and in-hospital death) of patients presenting with SCAD in Switzerland.
Methods
We performed an investigator initiated, multicentre, retrospective and prospective observational study including patients with non-atherosclerotic SCAD in 8 centres in Switzerland. Institutional ethics approval and patient consents were obtained. We recorded baseline demographics, precipitating/predisposing conditions, angiographic features, as well as in-hospital treatment and MACE.
Results
From August 2020 to March 2024, 264 patients were enrolled. Mean age was 53.4±10.7 years, 85% were women. Cardiovascular risk factors included hypertension (31%), familial history of myocardial ischaemic disease (31%), hypercholesterolemia (25%), active smoking (23%), and diabetes mellitus (3%). Patients presented with STEMI in 35% and with NST-ACS in 59% of cases. Treatment was conservative in 96% of patients. Percutaneous coronary intervention was performed in 4% of patients, coronary artery bypass grafting was limited to 1 patient. In-hospital MACE occurred in 11% of patients with following distribution: stroke/transient ischemic attack (4%), re-infarction (3%), repeat revascularization (2%), in-hospital death (2%). Dual anti-platelet therapy was prescribed in 55% of patients at discharge.
Conclusions
Contemporary SCAD patients are treated almost exclusively conservatively. In-hospital MACE rates are sizable, though in-hospital mortality is low.
