EXTRACORONARY VASCULAR ABNORMALITIES IN SPONTANEOUS CORONARY ARTERY DISSECTION: PREVALENCE, CHARACTERISTICS, AND CLINICAL IMPLICATIONS

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Objective: This study assesses the prevalence and characteristics of extracoronary vascular abnormalities (EVA) in patients with spontaneous coronary artery dissection (SCAD), a distinct form of acute coronary syndrome primarily affecting younger women. EVA include conditions like fibromuscular dysplasia (FMD) and aneurysms in non-coronary vessels. Design and method: A cohort of 87 patients (97.7% female, average age 44.5±9.1 years) with a history of SCAD enrolled in the SCAD-POL Registry was analyzed. The study included comprehensive reviews of medical records and angiographic imagery. All participants underwent head-to-pelvis computed tomography angiography for FMD and aneurysm screening, with EVA defined as the presence of any of these conditions in any vascular bed. Results: EVA was identified in 49.4% of the cohort, with 37.9% diagnosed with FMD and 23% with aneurysms. A minority (5.8%) presented with both conditions. FMD predominantly affected renal (23%) and cervical arteries (18.4%), while aneurysms were most prevalent in cervical (9.2%), intracranial and splenic arteries (6.9% each), with renal arteries less affected (5.7%). The EVA and non-EVA groups showed no significant laboratory differences. Concerning medical history, diabetes mellitus appeared in 1.2% EVA patient versus 5.8% non-EVA patients (p>0.05). Hyperlipidemia was noted in 20.9% EVA and 18.2% non-EVA patients (p>0.05). Hypertension was non-significantly more common in EVA patients (41.9% vs 29.5%, p=>0.05). Treatment modalities, including conservative management, percutaneous coronary intervention, and coronary artery bypass grafting, showed no significant differences between the groups. SCAD characteristics and outcomes, like left ventricular ejection fraction (LVEF) at discharge and recurrence rates, were similar (53.7% LVEF in EVA vs. 52.4% in non-EVA; with 2 recurrences in each group). Conclusions: This study reveals a significant prevalence of EVA in SCAD patients, with aneurysms being more common than previously reported. These findings emphasize the need for comprehensive vascular assessment in SCAD patients, considering the variable prevalence of FMD, aneurysms. This study contributes to a deeper understanding of EVA in SCAD, potentially influencing clinical management strategies.

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