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Aim <p>Spontaneous Coronary Artery Disease (SCAD) is a rare condition that mimics acute coronary syndrome and can lead to serious complications. This study evaluates SCAD characteristics, Major Adverse Cardiac Event (MACE) predictors, revascularization needs, and treatment outcomes.</p> Materials and methods <p>The single cardiac center, retrospective cohort study analyzed patients diagnosed with coronary artery dissection during coronary angiography between January 2014 and December 2019.</p> Results <p>Of 86 patients, 24(27.9%) experienced early MACE. Diffuse dissections (62.5% vs. 37.5%, <i>p</i> = 0.027) and ostium-involving dissections (33.3% vs. 8.1%, <i>p</i> = 0.006) were more frequent in the MACE group. Female patients (58.3% vs. 21.0%, <i>p</i> = 0.001) and those with lower pre-procedural ejection fraction (EF) (44.1 ± 13.5 vs. 55.0 ± 8.8, <i>p</i> = 0.004) or higher neutrophil to lymphocyte ratio (NLR) (5.59 ± 3.67 vs. 3.60 ± 2.46, <i>p</i> = 0.005) had a higher risk. Ostium-involving dissections (OR(Odds Ratio) = 9.41, <i>p</i> = 0.024) and low EF (OR = 0.931, <i>p</i> = 0.040) were independent predictors of MACE. Initial medical treatment is associated with higher unplanned revascularization compared to percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) (<i>p</i> = 0.030). Coronary tortuosity (<i>p</i> = 0.006) and spot lesions (<i>p</i> = 0.005) were associated with late revascularization.</p> Conclusion <p>High early MACE after SCAD is associated with female gender, high NLR, and low EF. Diffuse and ostium-involving dissections significantly increase the risk of MACE. Initial treatment has been shown to influence early revascularization. while coronary features like tortuosity predict long-term outcomes.</p> Clinical Trial Number <p>Not applicable.</p>

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Unplanned revascularization and major adverse cardiac events in spontaneous coronary artery disease patients: insights from a cardiac center

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月27日

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  • Levent Ceylan,
  • Mehmet Rum,
  • Mehmet Yilmaz,
  • Tamer Kehlibar,
  • Halil Emre Özlü

摘要

Aim

Spontaneous Coronary Artery Disease (SCAD) is a rare condition that mimics acute coronary syndrome and can lead to serious complications. This study evaluates SCAD characteristics, Major Adverse Cardiac Event (MACE) predictors, revascularization needs, and treatment outcomes.

Materials and methods

The single cardiac center, retrospective cohort study analyzed patients diagnosed with coronary artery dissection during coronary angiography between January 2014 and December 2019.

Results

Of 86 patients, 24(27.9%) experienced early MACE. Diffuse dissections (62.5% vs. 37.5%, p = 0.027) and ostium-involving dissections (33.3% vs. 8.1%, p = 0.006) were more frequent in the MACE group. Female patients (58.3% vs. 21.0%, p = 0.001) and those with lower pre-procedural ejection fraction (EF) (44.1 ± 13.5 vs. 55.0 ± 8.8, p = 0.004) or higher neutrophil to lymphocyte ratio (NLR) (5.59 ± 3.67 vs. 3.60 ± 2.46, p = 0.005) had a higher risk. Ostium-involving dissections (OR(Odds Ratio) = 9.41, p = 0.024) and low EF (OR = 0.931, p = 0.040) were independent predictors of MACE. Initial medical treatment is associated with higher unplanned revascularization compared to percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) (p = 0.030). Coronary tortuosity (p = 0.006) and spot lesions (p = 0.005) were associated with late revascularization.

Conclusion

High early MACE after SCAD is associated with female gender, high NLR, and low EF. Diffuse and ostium-involving dissections significantly increase the risk of MACE. Initial treatment has been shown to influence early revascularization. while coronary features like tortuosity predict long-term outcomes.

Clinical Trial Number

Not applicable.