Diagnostic Coronary Angiogram Research Articles

Characteristics of the Quality Improvement Content of Cardiac Catheterization Peer Reviews in the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

Peer review is recommended for quality assessment in all cardiac catheterization programs, but, to our knowledge, the content of peer reviews and the potential for quality improvement has not been described. To characterize the quality improvement content of cardiac catheterization peer reviews. This quality improvement study used retrospective case review of diagnostic angiography and percutaneous coronary intervention procedures to characterize the major adverse event review process of the US Department of Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) program from January 1, 2012, to December 31, 2016. Data review and analysis took place from November 2017 to August 2018. Percentage of peer reviews reporting substandard care and opportunities for quality improvement. A total of 196 643 diagnostic coronary angiograms and 62 576 percutaneous coronary interventions were performed in the Department of Veterans Affairs. Of these, 168 (0.1%) were triggered for review because of a self-reported major adverse event during the procedure. Of 152 cases with complete peer review data, care was adjudicated as not meeting the standard of care in 25 cases (16.4%). Concerns about operator judgment were identified in 46 cases (30.3%), about case selection in 26 (17.1%), about trainee supervision in 21 (13.8%), and about technical performance in 46 (30.3%). Reviewers made recommendations to improve operator performance in 63 cases (41.4%) and catheterization laboratory or hospital processes in 58 (38.2%). While substandard care is infrequently identified in peer review of catheterization laboratory complications in the Department of Veterans Affairs, the process often generates recommendations for quality improvement. Peer review programs should focus on identifying quality improvement opportunities and providing meaningful feedback to operators.

Appropriate use of elective coronary angiography in patients with suspected stable coronary artery disease.

The American College of Cardiology Foundation (ACCF) with other professional societies developed appropriate use criteria (AUC) for diagnostic coronary angiography. This study aims to examine the appropriate use of elective coronary angiography for patients with suspected stable coronary artery disease in an Irish tertiary referral center. A retrospective chart review of all elective outpatient diagnostic coronary angiograms performed in Cork University Hospital in 2014 was carried out. Data on demographics, risk factors, clinical presentation, and prior non-invasive investigations were extracted. Each patient was evaluated according to the 2012 ACCF appropriate use criteria and classified as appropriate, uncertain, or inappropriate. Univariable and multivariable logistic regression analysis was performed to investigate the factors that predict patients undergoing appropriate diagnostic coronary angiography. Of 417 elective outpatient diagnostic coronary angiograms, 259 (62%) were included in the analysis. Of these, 108 (42%) were classified as appropriate, 97 (37%) as uncertain, and 54 (21%) as inappropriate. In multivariable analysis, those with private health insurance were more likely to have an appropriate indication for coronary angiogram (OR 2.1, 95% CI 1.2-3.7) as were those with atrial fibrillation (OR 3.9, 95% CI 1.2-12.8). Ever smokers were less likely to have an appropriate indication for coronary angiogram than never smokers (OR 0.5, 95% CI 0.3-0.9). This is the first Irish study to evaluate the appropriate use of elective coronary angiography. Rates were similar to those of studies in other jurisdictions; however, there remains significant potential for quality improvement.

Procedural determinants of fluoroscopy time in patients undergoing cardiac catheterization.

Background & Objective:Due to increase in number of cardiac catheterization procedures safety concerns is an issue nowadays. Multiple diagnostic modalities use radiations, which also put a patient at higher cumulative radiation exposure. Therefore steps should be taken to minimize radiation exposure during cardiac catheterization. Hence determination of factors which prolong FT will result in better understanding of problem. This retrospective study was undertaken to determine factors responsible for prolong fluoroscopy time in patients undergoing coronary artery catheterization.Methods:This retrospective study was conducted at catheterization Laboratory National Institute of Cardiovascular Diseases, Karachi from June 2014 to June 2015. Patients of either gender, aged between 18 to 90 years undergoing cardiac catheterization procedures were included. Radiation exposure time was measured in terms of fluoroscopy time.Results:A total of 957 patients were included in this study out of which 731 were of diagnostic Coronary Angiograms (CA) and 226 were of Percutaneous Coronary Intervention (PCI). The mean age of the study participants was 54.12±10.89 years and majority 734(76.6%) were male. Mean fluoroscopy time (FT) in the patients subjected to PCI was 9.61±6.07 minutes while in cases for CA 4.17±4.13 minutes. FT for CA was observed significantly dependent on procedural access, operator’s experience, and LV angiogram. While FT for PCI was found dependent on number of stents deployed during the procedure.Conclusion:For invasive coronary angiographic procedures radial route increased fluoroscopy time. For percutaneous coronary intervention femoral and radial route fluoroscopy time were not significantly different.

Association of coronary artery disease and peripheral arterial disease in patients undergoing elective open abdominal aortic aneurysm repair

Introduction: Open surgical repair of abdominal aortic aneurysm (AAA) is one of the commonest aortic surgeries performed in tertiary care vascular centres. As association of coronary artery disease (CAD) and peripheral arterial disease (PAD) is high in these patients, need for cardiac risk stratification with or without coronary intervention prior to surgery and its effect on long term survival benefit have been debated. In our institution, all patients who undergo elective aortic aneurysm surgery undergo diagnostic coronary angiogram. Intervention (Percutaneous Coronary Intervention or coronary artery bypass surgery) was performed prior to surgery, if patient was symptomatic/ had multiple critical occlusions in coronary vessels. We also looked into the prevalence of peripheral arterial disease in these patients. Methods: Single centre retrospective study. 199 patients who underwent elective aortic aneurysm repair in the last 10 years were studied. Data was collected from electronic and hospital medical records and analysed. Results: Significant CAD was seen in 105 patients (52.7%) out of which 40 patients (20.1%) underwent preoperative intervention while 65 patients (32.7%) underwent surgery without the same. Prevalence of significant CAD in AAA was high (52.7%) whereas PAD was seen in 26 patients (13.1%). Conclusion: We suggest it worthwhile to assess the coronary status in these patients preoperatively for risk stratification. Prophylactic coronary revascularization should be individualized and can prevent post-operative adverse cardiac events. Medical treatment for concomitant CAD with no obvious inducible ischemia does not confer unfavorable outcomes. Presence of PAD should not be overlooked and should be identified and intervened in the same setting if critical to decrease the morbidity.

Minimizing radiographic contrast administration during coronary angiography using a novel contrast reduction system: A multicenter observational study of the DyeVert™ plus contrast reduction system.

To evaluate contrast media (CM) volume (CMV) saved using the DyeVert™ Plus Contrast Reduction System (DyeVert Plus System, Osprey Medical) in patients undergoing diagnostic coronary angiogram (CAG) and/or percutaneous coronary interventional (PCI) procedures performed with manual injections. Current guidelines advocate for monitoring and minimization of the total volume of CM in chronic kidney disease (CKD) patients undergoing invasive cardiac procedures. The DyeVert Plus System is an FDA cleared device designed to reduce CMV delivered during angiography and permit real-time CMV monitoring. We performed a multicenter, single-arm, observational study. Eligible subjects were ≥ 18 years old with baseline estimated glomerular filtration rate (eGFR) 20-60 mL/min/1.73 m2 . The primary endpoint was % CMV saved over the total procedure. A secondary objective was to evaluate adverse events (AEs) related to DyeVert Plus System or to CM use. A total of 114 subjects were enrolled at eight centers. Mean age was 72 ± 9 years, 72% were male, and mean body mass index was 29 ± 5. Baseline eGFR was 43 ± 11 mL/min/1.73 m2 . CAG-only was performed in 65% of cases. One hundred and five subjects were evaluable for the primary endpoint. Mean CMV attempted was 112 ± 85 mL (range 22-681) and mean CMV delivered was 67 ± 51 mL (range 12-403), resulting in an overall CMV savings of 40.1 ± 8.8% (95% CI 38.4, 41.8; P < 0.0001) per procedure. Image quality was maintained in all but one case where the system was turned off for one injection. No DyeVert Plus System-related AEs were reported. Acute kidney injury (AKI; defined as serum creatinine rise of >0.3 mg/dL from baseline) was reported in 11 cases with seven occurring in subjects with baseline eGFR < 30 and three AKI events were attributed to CM. AKI rates increased as CMV/eGFR ratios increased. These data suggest DyeVert Plus System use in CKD patients undergoing CAG and/or PCI results in clinically meaningful CMV savings while maintaining image quality.

Premedication to reduce anxiety in patients undergoing coronary angiography and percutaneous coronary intervention

AimsIn this study, we examined the effects of the routinely administration of benzodiazepines on reducing periprocedural anxiety versus no premedication.MethodsIn this open label study, we enrolled 1683 patients undergoing diagnostic...

Epidermal bulla: A dermatology complication of radial artery compression band

Patent hemostasis technique is used with the trans radial (TR) band to prevent radial artery occlusion following diagnostic coronary angiogram or percutaneous coronary intervention using radial artery access. We report epidermal bulla as a complication of TR band usage and a modified patent hemostasis technique using barbeau test to prevent this complication.

Feasibility of using ultra-low pulse rate fluoroscopy during routine diagnostic coronary angiography.

IntroductionCoronary angiogram, while a powerful diagnostic tool in coronary artery disease, is not without an associated risk from ionising radiation. There are a number of factors that influence the amount of radiation the patient receives during the procedure, some of which are under the control of the operator. One of these is an adjustment of the fluoroscopic pulse rate. This study aims to assess the feasibility of using ultra‐low pulse rate (3 pulses per second(pps)) fluoroscopy during routine diagnostic coronary angiogram procedures and the effect it has on fluoroscopy time, diagnostic clarity and radiation dose.MethodsA retrospective study of three operators each undertaking 50 coronary angiogram procedures was performed. One of the operators used a pulse rate of 3 pps and 6 pps for fluoroscopic screening while the control groups used the standard 10 pps mode utilised at this centre.ResultsResults demonstrated no reduction of diagnostic clarity, up to a 58% reduction in Dose Area Product and no increase in fluoroscopy time with the 3 pps setting.ConclusionsFindings from this pilot study suggest that utilisation of ultra‐low pulse rate fluoroscopy in routine transfemoral diagnostic coronary angiography in the catheterisation laboratory is feasible.

Prevalence of abnormal glucose regulation in libyan patients presenting for elective coronary angiography

Background: Patients with coronary artery disease (CAD) frequently have multiple risk factors. Diabetes and impaired glucose tolerance (IGT) have been associated with cardiovascular events and cardiovascular disease mortality. Aim of the study: This study aims to determine the prevalence of abnormal glucose regulation (AGR) among Libyan patients, presenting for elective coronary angiography. Methods: All patients referred for a diagnostic coronary angiogram at the Catheterization Laboratory of National Heart Centre, Tajora, Tripoli, over a period of 1 year from April 2007 to March 2008, were included after consent. Patients with a history of diabetes were excluded from the study. Diagnostic coronary angiogram was performed for all included patients as well as a standard oral glucose tolerance test (OGTT) with 75 GM glucose. Results: Ninety-nine patients were included in our study, with a mean age of 54.6 ± 11.2 years. 49 (49.5%) of the enrolled patients showed either impaired or diabetic fasting or 2-h OGTT results. 22 (22.2%) patients were diabetic based on fasting blood glucose or 2-h OGGT result, and 21 (21.2%) have IGT. Of the 15 (15.2%) patients with impaired fasting glucose, 7 (46.7%) patient showed diabetic glucose tolerance, and 2 (13.3%) patients have IGT. Among patients with AGR, coronary angiogram showed significant CAD in 36 (73.5%), compared to 28 (56%) of patients with normal fasting and 2-h OGTT results. Conclusion: Abnormal glucose regulation was high among Libyan patients presented for elective angiography. OGTT should be part of the evaluation in this high-risk population.

Impact of a novel contrast reduction system on contrast savings in coronary angiography – The DyeVert randomised controlled trial

AimsThe most prominent procedure-related and thus modifiable risk factor for contrast-induced acute kidney injury is contrast media (CM) volume. The DyeVert™ system has been designed to reduce the amount of CM. The primary objective of this randomised controlled trial was thus to examine whether the novel DyeVert™ contrast reduction system (Osprey Medical Inc., Minnetonka, MN, USA) leads to a reduction in CM volume in patients undergoing diagnostic coronary angiography. MethodsPatients scheduled for a diagnostic coronary angiogram were randomised to angiography with or without the DyeVert™ system. The primary efficacy endpoint was mean CM volume. Image quality was evaluated by an independent reviewer blinded to treatment allocation. ResultsA total of 96 patients underwent randomisation. Baseline characteristics were well balanced between groups. Use of the DyeVert™ system resulted in a significant 41.0% reduction in CM volume (36.9±10.9mL versus 62.5±12.7mL, p<0.001). Image quality using the DyeVert™ system was non-inferior compared to control (p=0.03). There were no device-related adverse events. ConclusionsThe DyeVert™ system leads to significant reduction in CM volume in patients undergoing diagnostic coronary angiography, while maintaining image quality.

Left Main Coronary Artery Diverticulum: Case Report and Review of the Literature

Coronary artery disease is a major cause of morbidity and mortality, and while most commonly is atherosclerotic, it can present with variable manifestations, both congenital and acquired. One such manifestation is coronary aneurysm, which is a localized dilatation of a coronary artery wall segment to greater than 1.5 times the adjacent normal segments. While a dilated outpouching of a coronary artery has been commonly classified as a coronary aneurysm, a non-dilated outpouching is rare and is referred to as a diverticulum, with only one previous case report in the literature. It is conceivable that other cases of coronary artery diverticulum may have been previously reported as an aneurysm, given the overlapping angiographic appearance. We present a case of a 72-year-old female patient with an incidental finding of left main coronary artery diverticulum on diagnostic coronary angiogram done for preoperative liver transplantation evaluation.

“Bringing on the light” in a complex clinical scenario: Optical coherence tomography–guided discontinuation of antiplatelet therapy in cancer patients with coronary artery disease (PROTECT-OCT registry)

Cancer patients with recently placed drug-eluting stents (DESs) often require premature dual antiplatelet therapy (DAPT) discontinuation for cancer-related procedures. Optical coherence tomography (OCT) can identify risk factors for stent thrombosis such as stent malapposition, incomplete strut coverage and in-stent restenosis and may help guide discontinuation of DAPT. We conducted a single-center prospective study in cancer patients with recently placed (1-12 months) DES who required premature DAPT discontinuation. Patients were evaluated with diagnostic coronary angiogram and OCT. Individuals with appropriate stent strut coverage, expansion, apposition, and absence of in-stent restenosis or intraluminal masses were considered low risk and transiently discontinued DAPT to allow optimal cancer therapy. Patients who did not meet all these criteria were considered high risk and underwent further endovascular treatment when appropriate and bridging with low-molecular weight heparin. The incidence of adverse cardiovascular events was assessed after the procedure and at 12 months. A total of 40 patients were included. Twenty-seven patients (68%) were considered low risk by OCT criteria and DAPT was transiently discontinued. Thirteen patients (32%) were considered high risk with one or more OCT findings: uncovered stent struts (4 patients, 10%); stent underexpansion (3 patients, 8%); malapposition (8 patients, 20%); in-stent restenosis (2 patients, 5%). The high-risk patients with uncovered stent struts and malapposition underwent additional stent dilatation. There were no cardiovascular events in the low-risk group. One myocardial infarction occurred in the high-risk group. Fourteen non-cardiac deaths were registered before 12 months due to cancer progression or cancer therapy. OCT imaging allows identification of low-risk cancer patients with DES placed who may safely discontinue DAPT and proceed with cancer-related surgery or procedures.

Pulmonary Vein Isolation for Atrial Fibrillation Can Be Achieved With Low Radiation Exposure

Atrial fibrillation is common and management by pharmacotherapy is limited by modest efficacy and significant toxicities. Pulmonary vein isolation (PVI) is a safe and effective alternative in select patients with atrial fibrillation. However, prolonged procedure time raises concerns of health risks from radiation exposure. This study aims to determine the significance of radiation exposure from PVI. In this study, we retrospectively reviewed patient demographics, fluoroscopy time, entrance skin dose and dose area product in 80 cases of PVI, radiofrequency ablation for atrial flutter and diagnostic coronary angiogram performed in our institution. Compared to other procedures, patients who underwent PVI were younger (age, mean±standard error of mean, 59.4±1.1 years old, p<0.0001) and were more likely to be male (82%, p<0.001). Body mass index was similar between the three groups. The median (and interquartile range) fluoroscopy time was similar between PVI (20.8 and 13.1-30.7mins) and flutter ablation (17.6 and 11.1-26.1mins) but longer than diagnostic angiography (4.2 and 2.3-6.7mins, p<0.0001). Entrance skin dose was similar between PVI and flutter ablation groups but significantly higher in the diagnostic angiography group, with median and IQR for PVI vs. flutter ablation vs. diagnostic angiography, 100.4 (52.8-179.9) vs. 73.2 (37.0-142.1) vs. 393.5 (276.1-555.6) mGy (p<0.0001). Dose area product in PVI (1831.2 and 887.7-3460.8cGycm2) was higher than flutter ablation (1077.8 and 452.9-2410.2cGycm2, p<0.05) but lower than the diagnostic angiography group (3446.8 and 2341.9-5283.1cGycm2, p<0.0001). The fluoroscopy time and entrance skin dose for PVI decreased over time, likely due to increased operator experience. Despite prolonged procedure time, radiation exposure from PVI was comparable to, or lower than, other fluoroscopy-guided cardiac procedures.

Simulation-based education leads to decreased use of fluoroscopy in diagnostic coronary angiography.

The aim of this study is to determine whether simulation-based education (SBE) translates into reduced procedure time, radiation, and contrast use in actual clinical care. As a high volume procedure often performed by novice cardiology fellows, diagnostic coronary angiography represents an excellent target for SBE. Reports of SBE in interventional cardiology are limited and there is little understanding of the potential downstream clinical impact of these interventions. All diagnostic coronary angiograms performed at a single center between January 1, 2011 and June 30, 2015 were analyzed. Random effects linear regression models were used to compare outcomes between procedures performed by 12 cardiology fellows who underwent simulation-based training and those performed by 20 traditionally trained fellows. Thirty-two cardiology fellows performed 2,783 diagnostic coronary angiograms. Procedures performed by fellows trained with SBE were shorter (mean of 23.98 min vs. 24.94 min, P = 0.034) and were performed with decreased radiation (mean of 56,348 mGycm2 vs. 66,120 mGycm2 , P < 0.001). After controlling for year in training, procedure year, access site, and supervising attending physician, training on the simulator was independently associated with 117 fewer seconds of fluoroscopy time per procedure (P = 0.04). Diagnostic coronary angiography SBE is associated with decreased use of fluoroscopy in downstream clinical care. SBE may be a useful tool to reduce radiation exposure in the cardiac catheterization laboratory.

VSD with severe aortic regurgitation with an anomalous coronary artery: a rare case

Coronary anomalies are found in less than 1% of diagnostic coronary angiograms. The clinical relevance of these anomalies varies from insignificant to potentially lethal. Here, we present a rare case of a 46-year-old male who was previously diagnosed with severe aortic regurgitation with sub-aortic ventricular septal defect with coronary cameral fistula. Coronary angiography and 2-D echocardiography were showing that this fistula was connecting from the left circumflex artery to the left atrium (LA). Intra-operatively, there was no coronary cameral fistula; it was just an anomalous coronary artery arising from the left circumflex artery and ending upon the left atrial wall. This rare entity should be discussed; as in the literature, anomalous coronary in a case of ventricular septal defect with aortic regurgitation has not been reported yet.

Association of Left Coronary Dominance with In- Hospital Adverse Outcomes after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

Background: Coronary dominance affects on in-hospital outcomes of patients with acute coronary syndrome and also affects the outcome following percutaneous coronary intervention. Left dominant anatomy is believed to be associated with worse prognoses for patients with acute coronary syndrome undergoing percutaneous coronary. This study evaluated the manner in which coronary dominance affects in-hospital adverse outcomes of acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI).Methods: Data were analyzed from 149 ACS patients who underwent PCI between November 2014 and October 2015 at National Institute of Cardiovascular Diseases (NICVD), Dhaka. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right dominant plus co-dominant anatomy (RD+Co group) and those with left dominant anatomy (LD group).Results: Total adverse in-hospital outcome is 8.7% patients. In LD group 23.1% patients were experienced adverse in-hospital outcome, on the contrary 5.7% of the patients with RD+Co group did have such experience. About 2.7% patients developed arrhythmia, 2.7% cardiogenic shock, 2% acute left ventricular failure and 0.7% ischaemic chest pain of the both groups. Among them arrhythmia, acute left ventricular failure and cardiogenic shock were more common in LD group than RD+Co (7.7% vs. 1.6%, 7.7% vs. 0.8% and 7.7% vs. 1.6%) group. Multivariate logistic regression analysis revealed that smoking, diabetes mellitus and left coronary dominance were the independent predictors for developing adverse in-hospital outcome with ORs being 1.317, 1.074 and 6.553 respectively (p &lt;0.05).Conclusion: Patients of left coronary dominant had higher in-hospital adverse outcome compared with patients of right dominant plus co-dominant in a population with acute coronary syndrome who underwent percutaneous coronary intervention and left dominant anatomy was an independent predictor for developing adverse in-hospital outcome.Cardiovasc. j. 2017; 9(2): 129-134

Manual thrombectomy in Primary Percutaneous Coronary Intervention via the Transradial Approach: A case report

The main goal of primary percutaneous coronary intervention (PPCI) is to achieve not only restoration of flow in the epicardial coronary artery, but also reperfusion at the level of myocardial tissue. Distal embolization is a possible complication of PPCI leading to lack of myocardial reperfusion and microvascular injury. Thrombus aspiration during PPCI has been proposed to prevent embolization. Although the use of thrombectomy devices to aspirate thrombus during primary PCI is not used routinely, there is growing evidence suggesting the use of thrombus aspiration catheters during PCI. We are reporting the case of a 53-year-old diabetic, hypertensive woman presenting with acute infero-posterior ST elevation myocardial infarction (STEMI) with right ventricular infarction. She underwent diagnostic coronary angiogram through transradial approach which revealed total occlusion of mid right coronary artery (RCA). Multiple runs of aspiration were performed using Diver Aspiration Catheter-6F and thrombus was aspirated from RCA. After successful thrombus aspiration, dramatic improvements in both coronary flow and ST-segment resolution were achieved.University Heart Journal Vol. 11, No. 2, July 2015; 90-93

756 - Systemic inflammation after transradial coronary angiogram: statistically (but not clinically) significant?

Aims: To evaluate if transradial diagnostic coronary angiogram by itself could lead to a systemic inflammation. Methods: In 96 patients with baseline hs-CRP level <5 mg/L, venous samples were obtained the day before the procedure and the day after. Coronary angiogram was performed with 4, 5 or 6 French radial access catheters. Results: Mean hs-CRP at admission was 2.3 mg/L ± 1.4. At day 2, the mean CRP level was 2.7 mg/L±1.9, with a 0.4 mg/L (17%) statistically significant elevation, p<0.0001. No radial access complication (thrombosis or hematoma) occurred. The variation of hs-CRP was positively correlated with age (r=0.20; p=0.04), elevation of creatin kinase (r=0.20; p=0.03) and negatively with amount of contrast (r=0.20; p=0.03). Conclusion: In patients with diagnostic coronary angiogram performed through radial access, there is a statistically significant elevation of the biological inflammatory response, whose clinical significance remains elusive.

Percutaneous intervention for Optitorque tiger catheter-induced dissection of the right coronary artery and aortic root

A 59-year-old female developed iatrogenic Type F spiral dissection of the right coronary artery (RCA) with retrograde extension as Type III aortic dissection (AD) during diagnostic coronary angiogram using 5 Fr Optitorque Tiger catheter. The spiral dissection of RCA was treated with angioplasty. AD was followed up with conservative management. The prompt identification of the starting point, the true lumen, and exit point of the dissection is the keys to the successful percutaneous revascularization. Visual eyeballing into multiple angiographic views is of immense help in the situation where optical coherence tomography and intravenous ultrasound are not available.

Spontaneous coronary artery dissection: A retrospective analysis of 19,676 coronary angiograms

Aim: Spontaneous coronary artery dissection (SCAD) is a rare cause of angina, myocardial infarction (MI), and sudden cardiac death (SCD) and may frequently manifest as acute coronary syndrome (ACS). The diagnosis of SCAD relies on angiographic visualization of a radiolucent intimal flap. Therapeutic options include medical therapy, percutaneous coronary interventions, and bypass surgery. The aim of this study is to analyze the clinical profile, inhospital outcomes, management, and follow-up of patients with angiographic SCAD. Methods: About 19,676 diagnostic coronary angiograms (CAGs) were reviewed retrospectively during a 2-year period; 64 patients had SCAD and were included in the study. Complete medical histories before and during the event as well as treatment regimens were obtained from patients' hospital files. Results: A total of 64 cases of SCAD were considered for the study within an age range of 25–70 years. Fifty-eight patients presented with ACS, two patients presented with unstable angina, one patient presented with rheumatic mitral stenosis in atrial fibrillation, one patient presented with non-ST-elevation myocardial infarction, one patient with dilated cardiomyopathy with left ventricular dysfunction, and one patient with effort. Out of 64 patients, four patients died and the average hospital stay is 3–5 days. Conclusion: SCAD occurs in 0.32% of patients undergoing CAG for evaluation of coronary artery disease. Majority of SCAD occurs in men. The left coronary artery is most commonly affected. The inhospital outcomes are good. Most of the patients with SCAD have good prognosis following optimal medical therapy.