Aims: Spontaneous coronary artery dissection (SCAD) is an under-recognized and important cause of myocardial infarction in young women. Recurrent SCAD is frequent but poorly understood. We aim to explore the clinical and angiographic characteristics, and outcomes of recurrent SCAD.
Methods and Results: Patients with SCAD extension or recurrence prospectively followed at Vancouver General Hospital were included. SCAD diagnosis was confirmed by 2 experienced cardiologists. Detailed medical history, baseline demographics, angiographic results, and clinical details of index SCAD and recurrent events were recorded. SCAD extension was defined as angiographic extension of previously dissected coronary segment, and recurrent SCAD was defined as de novo spontaneous dissection. We identified 43 patients with SCAD extension or recurrence with mean age 48.9±8.4 years, 38/43 were women, and 32/43 had fibromuscular dysplasia. Nine patients had SCAD extension at median time of 5 (1-19) days, while 34 patients had recurrent SCAD at median time of 1487 (107-6461) days after index SCAD event. All SCAD extension patients had worsening of index dissected segment, with 5/9 involving extension to adjacent segments. While all recurrent SCAD patients had de-novo dissections affecting coronary segments distinct from the index dissection.
Conclusions: Recurrent SCAD invariably affected new segments distinct from previously dissected segments.