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Incidence, angiographic features, clinical phenotype and therapeutic challenges of myocardial infarction due to spontaneous Coronary artery dissection in central Greece

John Papanikolaou*, Nikolaos Platogiannis, Vasileios Laschos, Konstantinos Spathoulas, Dimitrios Platogiannis

Background: Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction (MI), typically affecting subjects with low index of suspicion for coronary artery disease. Data regarding SCADrelated MI in central Greece is extremely sparse. Methods: In this three-year study (January 2016-December 2018), all patients who admitted/transferred due to ST-elevation MI (STEMI) or non-STEMI (NSTEMI) were prospectively evaluated. Baseline, predisposing conditions, angiographic and revascularization data, in-hospital and long-term events were meticulously recorded. Results: Among 474 MI patients enrolled, 439 (92.6%) underwent coronary angiography. SCAD accounted for 1.82% (8/439) of MIs overall [2.5% (6/235) of STEMIs and 1% (2/204) of NSTEMIs; P=0.219]. SCAD affected predominately women (7/8; 87.5%). The incidence of SCAD was significantly increased in women with STEMI (7% vs. 0%, P=0.001) but not NSTEMI (1.3% vs. 0.79%, P=0.7194), compared to men. Among women with SCAD, 57.1%(4/7) were post-menopausal, none was pregnant, and 100% (7/7) revealed a left anterior descending artery (LAD) dissection. The prevalence of SCAD in women aged<55 compared to women ≥ 55 years-old was significantly increased in MI overall, STEMI and NSTEMI subsets (13.95% vs. 0.85%; 18.5% vs. 1.7%; 6.2% vs. 0%, P=0.0003;0.0049;0.0494, respectively). Type 2 lesion (diffuse smooth stenosis) was the most common angiographic feature (6/8;75%), while type 1 (multiple radiolucent lumen) was less found (2/8;25%). Established risk factors or precipitating stressors reported in other SCAD populations either failed to be related or showed weak relationship with SCAD in our specific region. Medical therapy was prioritized against early coronary revascularization with favorable outcomes. Conclusion: Our study provides an incidence of 1.82% for SCAD-induced MI in central Greece. SCAD mainly affects women, who are typically aged<55, non-pregnant (rather postmenopausal), and it predominately occurs as type 2 LAD disease; established precipitating SCAD stressors/disorders show weak pathogenic role in our specific population.