TCT-48: Medical therapy and clinical outcomes with spontaneous coronary artery dissection
Eng LK, Starovoytov A, Humphries K, Mancini GJ, Saw J. TCT-48 Medical Therapy and Clinical Outcomes with Spontaneous Coronary Artery Dissection. Journal of the American College of Cardiology. 2016;68(18). doi:10.1016/j.jacc.2016.09.192.
Conservative management is currently the preferred therapy for patients with spontaneous coronary artery dissection (SCAD). However, the optimal medical regime remains controversial. Our objective is to evaluate the use of cardiac medications in contemporary clinical management of SCAD, and their potential association with clinical outcomes.
We reviewed non-atherosclerotic SCAD patients who were prospectively followed at the Vancouver General Hospital SCAD clinic, and enrolled in our SCAD registries. Baseline characteristics, medications on admission, discharge, and follow-up were examined. Major adverse cardiac events (MACE) at follow-up were recorded and included repeat MI, death, stroke/TIA.
We prospectively followed 286 consecutive SCAD patients. Mean age was 52.5±9.4 years, and most were women (90.2%). All presented with myocardial infarction (MI). After an acute event, patients were discharged on aspirin (93.7%), P2Y12 inhibitor (64.5%, predominantly clopidogrel), beta-blocker (BB) (82.8%), angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor blocker (RAAS) (53.5%), calcium channel blocker (CCB) (15.7%), and statin (52.9%). There were 195 patients followed for at least 1 year. At 1 year, the majority remained on aspirin (92.8%) and BB (75.4%), but there were lower usage of RAAS (47.7%), statin (40.0%), P2Y12 inhibitor (26.7%), and CCB (19%). The overall median follow-up was 3.1 (IQR 2.0-5.7yr) and MACE was 20.5%. The use of CCB at last follow-up was associated with higher incidence of repeat MI (29.7% vs. 15.2%, p=0.038), and the use of BB at last follow-up was associated with a trend to lower incidence of repeat MI (15.0% vs. 27.1%, p=0.058).
Our observational data showed that aspirin and BB were commonly used for SCAD management. Patients on CCB appeared to have higher repeat MI at long-term follow-up. Whereas, BB was associated with a trend in reduction of repeat MI. Future studies are warranted to assess the relationship between medications and outcomes in SCAD patients.