Introduction: Spontaneous coronary artery dissection (SCAD) is a rare clinical entity and not much is known about the factors associated with mortality in these patients.
Objective: Our aim was to find the factors associated with mortality in patients presenting with SCAD.
Methods: We searched the National Inpatient Sample (NIS) from 2008 to 2014 using International Classification of Diseases (ICD-9-CM) codes for patients with primary diagnosis of SCAD (414.12). We also identified patients who underwent percutaneous coronary intervention (PCI) using ICD 9 codes (00.66, 36.06, 36.07). We used chi-square test and ANOVA to compare categorical and continuous variables respectively. We performed multivariate binary logistic regression to identify adjusted odds-ratio (AOR) for in-hospital all-cause mortality. We performed multivariate linear regression to identify factors associated with differences in length of stay (LOS).
Results: We identified a total of 1,513 (weighted) patients admitted with the primary diagnosis of coronary artery dissection. Mean age was 55.13 years +/- 14.31 years. However, females were younger (mean age of 54 years) than males (56.38 years). A total of 878 (58.1%) patients were females. A total of 676 (48%) patients underwent PCI. A total of 75 (5%) patients died during the hospitalization. Median LOS was 3 days. Median total charges for hospitalization was $59,176. Patients who underwent PCI had AOR of 0.163 (CI = 0.061 - 0.436; p < 0.0001) for in-hospital all-cause mortality compared to patients who did not undergo PCI. PCI did not make any difference in mean LOS (p = 0.325). Every unit increase in comorbidity score and age had AOR for in-hospital mortality of 1.237 (CI = 1.147 - 1.334; p <0.0001) and 1.09 (CI = 1.05 - 1.121; p <0.0001) respectively. Black patients had AOR of 0.201 (CI = 0.062 - 0.656; p=0.008) compared to white patients for in-hospital mortality.
Conclusions: PCI improved the all-cause in-hospital mortality in patients admitted with the primary diagnosis of SCAD. Age, white race, and higher comorbidity burden were associated with increased mortality.