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Background <p>Spontaneous coronary artery dissection (SCAD) is a rare, but increasingly recognised cause of myocardial infarction. Our aim was to provide comprehensive real-world data on the prevalence of SCAD among patients who present with ST-segment elevation myocardial infarction (STEMI).</p> Methods <p>Retrospective analysis of medical records and review of coronary angiograms allowed identification of all SCAD cases in a cohort of consecutive patients with STEMI, and review of clinical data provided further characterisation.</p> Results <p>Among 2707 consecutive STEMI patients, the prevalence of SCAD was 0.9% (<i>n</i> = 24). In 9 cases, the diagnosis of SCAD diagnosis had been missed during clinical routine (37.5%). Compared to non-SCAD-STEMI, SCAD patients were younger (median age 53.5 vs. 66.0&#xa0;years, <i>p</i> = 0.001) and more likely to be female (75.0% vs. 29.7%, <i>p</i> &lt; 0.001). The most common symptom was typical angina (chest pain limited to the thorax, 75%). Importantly, six patients (25%) experienced cardiac arrest, either as the presenting symptom before (<i>n</i> = 2) or after first medical contact (<i>n</i> = 3), or during hospitalisation (<i>n</i> = 1). The most common angiographic pattern was SCAD type 4 (complete vessel occlusion, 37.5%), followed by type 2a (29.2%) and 2b (25%). Intravascular imaging was used in 25% (<i>n</i> = 6). 58.3% of patients with SCAD-STEMI underwent percutaneous coronary intervention (PCI). Complications occurred in 50% of PCI, mostly due to propagation of intramural hematoma. All patients survived to hospital discharge. Long-term follow-up was available in 50% of patients. While event rate was low, recurrence of SCAD did occur, in some cases after several years.</p> Conclusion <p>In a Western European cohort of STEMI patients, SCAD was the underlying cause in approximately 1% of all cases. The true incidence may be higher since cardiac arrest occurred in one quarter of all patients within the cohort. Interventional treatment, while often required in SCAD-STEMI, is fraught by a high complication rate.</p> Graphical abstract <p></p>

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STEMI caused by spontaneous coronary artery dissection: prevalence, patient characteristics and outcomes

  • 期刊论文

  • 发表日期：

    2026年3月26日

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  • Stefan Malleier,
  • Luise Gaede,
  • Susanne Jung,
  • Mohamed Marwan,
  • Stephan Achenbach,
  • Monique Tröbs

摘要

Background

Spontaneous coronary artery dissection (SCAD) is a rare, but increasingly recognised cause of myocardial infarction. Our aim was to provide comprehensive real-world data on the prevalence of SCAD among patients who present with ST-segment elevation myocardial infarction (STEMI).

Methods

Retrospective analysis of medical records and review of coronary angiograms allowed identification of all SCAD cases in a cohort of consecutive patients with STEMI, and review of clinical data provided further characterisation.

Results

Among 2707 consecutive STEMI patients, the prevalence of SCAD was 0.9% (n = 24). In 9 cases, the diagnosis of SCAD diagnosis had been missed during clinical routine (37.5%). Compared to non-SCAD-STEMI, SCAD patients were younger (median age 53.5 vs. 66.0 years, p = 0.001) and more likely to be female (75.0% vs. 29.7%, p < 0.001). The most common symptom was typical angina (chest pain limited to the thorax, 75%). Importantly, six patients (25%) experienced cardiac arrest, either as the presenting symptom before (n = 2) or after first medical contact (n = 3), or during hospitalisation (n = 1). The most common angiographic pattern was SCAD type 4 (complete vessel occlusion, 37.5%), followed by type 2a (29.2%) and 2b (25%). Intravascular imaging was used in 25% (n = 6). 58.3% of patients with SCAD-STEMI underwent percutaneous coronary intervention (PCI). Complications occurred in 50% of PCI, mostly due to propagation of intramural hematoma. All patients survived to hospital discharge. Long-term follow-up was available in 50% of patients. While event rate was low, recurrence of SCAD did occur, in some cases after several years.

Conclusion

In a Western European cohort of STEMI patients, SCAD was the underlying cause in approximately 1% of all cases. The true incidence may be higher since cardiac arrest occurred in one quarter of all patients within the cohort. Interventional treatment, while often required in SCAD-STEMI, is fraught by a high complication rate.

Graphical abstract