Long-Term Follow-up of Spontaneous Coronary Artery Dissection in Young Women: A Single-Center Tertiary Referral Cohort.

Abstract

Objective: Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute coronary syndrome (ACS) and sudden cardiac death, particularly in women aged 50 years or younger, including those without typical atherosclerotic coronary lesions. This study aimed to evaluate the clinical presentation, angiographic features, management strategies, and outcomes of patients with SCAD.

Method: This retrospective, single-center study included female patients aged 50 years or younger who underwent coronary angiography for ACS between January 2019 and January 2025. Patients presenting with chest pain, ST-T segment changes, and/or elevated high-sensitivity cardiac troponin levels were evaluated. The diagnosis of SCAD was established according to angiographic criteria and categorized using the Yip-Saw classification system.

Results: Among 352 women screened, 40 patients were diagnosed with SCAD, including 18 with ST-segment elevation myocardial infarction and 22 with non-ST-segment elevation myocardial infarction. According to the Yip-Saw classification, Type 3 SCAD was the most frequently observed angiographic pattern. The left anterior descending artery was the most commonly involved vessel. Most patients (n=35) underwent percutaneous coronary intervention, whereas 3 patients were managed conservatively and 2 underwent coronary artery bypass grafting. During follow-up, repeat revascularization was required in only one patient. Two patients died: one from cardiogenic shock during the index event and the other from complications of heart failure.

Conclusion: SCAD is an important but underdiagnosed cause of ACS in young women. The mortality rate in the study population was 5%. These findings provide real-world observational data and should be confirmed in larger, multicenter, prospective studies.