Abstract 13231: Fibromuscular Dysplasia Screening in Patients With Spontaneous Coronary Artery Dissection

Abstract

Introduction: Spontaneous coronary artery dissection (SCAD) is commonly associated with fibromuscular dysplasia (FMD), a vascular condition that can lead to aneurysm and dissection in any arterial bed. SCAD and FMD are increasingly being diagnosed, especially in women. Our objective is to describe screening patterns of FMD over time among patients with SCAD. Methods: We conducted a retrospective cohort study, identifying patients treated for SCAD in the University of Pennsylvania Health System from 2005-2019 using ICD-9 (414.12) and ICD-10 (I25.42) codes. Charts were manually reviewed and clinical data were abstracted. Screening modalities included CT angiogram (CTA) or MR angiogram (MRA) of the head, neck, or abdomen; carotid or renovascular ultrasound; or renal angiography. Complete screening was defined as having head, neck, and abdominal imaging. We indexed cases by date of SCAD event. Time categories were calculated by quartiles of patients. We used Fisher’s exact test to compare proportions and Cochran-Armitage trend test to compare trends over time. Results: We identified 121 patients with SCAD with ≥ 6 months of follow-up prior to the COVID-19 pandemic. FMD screening rates by any modality were higher among patients with SCAD in 2018-2019 compared to 1993-2011 (62% vs. 28%, p=0.009 for trend), see Figure. Rates of complete screening remained low and did not change over time (p=0.451 for trend). In 2018-2019, only 41% of patients were screened with CTA or MRA of the abdomen, 26% with CTA or MRA of the neck, and 15% with CTA or MRA of the head. Patients undergoing complete screening had higher rates of FMD diagnosis compared to those undergoing any screening (63% vs. 37%, p=0.036). Conclusions: While overall FMD screening in SCAD patients has increased, complete screening rates remain low. FMD was diagnosed more often in patients undergoing complete screening, highlighting the importance of head, neck, and abdominal imaging in all patients with SCAD.