Variability of time to healing of Spontaneous Coronary Artery Dissection assessed through coronary CT angiography

Abstract

Abstract Background Spontaneous coronary artery dissection (SCAD) results from a spontaneous, non-traumatic, and non-iatrogenic separation of the coronary arterial wall by intramural hematoma caused by intimal tear or spontaneous hemorrhage that is unrelated to atherosclerosis. SCAD is an important cause of myocardial infarction particularly in young to middle-aged women. Natural history of this condition is poorly understood: spontaneous healing has been demonstrated through coronary angiography in the vast majority of patients at long term follow up, but the timing of healing is still not clear. Nowadays, Coronary CT angiography (CCTA) is emerging as a noninvasive option to evaluate SCAD healing at least for coronary arteries with diameter ≥2mm and could help in understanding the natural history of this condition. Methods In this single-centre, retrospective study, patients affected by SCAD between 2017 and 2022 were included. Patients with SCAD involving coronary arteries with diameter ≥2mm who did not undergo percutaneous coronary intervention (PCI) and underwent to at least one CCTA during follow up were evaluated with regard to evolution of SCAD and time to healing. Results Among 93 patients for whom diagnosis of SCAD was posed by coronary angiography, 33 conservatively managed patients (84.8% female, mean age 51.8±12.3 years) underwent to at least one CCTA during follow up. At a median time of 49 days (IQR 13 to 82 days), a complete healing of SCAD was demonstrated in 6 patients (18.2%), while most of the patients showed a stability or partial healing and 1 patient (3.0%) an extension of SCAD. During further follow up, of 10 patients who did not show a significant healing at the first CCTA, 4 patients showed a complete healing, while 6 patients showed a stability of SCAD extension or only partial healing at the longest available CCTA follow up (median follow up 191 days, IQR 96 to 249 days). As regards clinical events, no death, myocardial infarctions, or target vessel PCIs were reported during follow up. Conclusion Spontaneous healing is commonly seen in SCAD and can be demonstrated by CCTA. However, the timing of complete healing is largely variable between individuals: therefore, studies focusing factors impacting natural history of SCAD are needed.