抄録
Background: Spontaneous coronary artery dissection (SCAD) causes acute myocardial infarction (AMI). Clinical characteristics of SCAD patients remain insufficiently understood.
Methods and Results: We analyzed AMI patients aged ≤60 years using the nationwide Japanese Registry of All Cardiac and Vascular Diseases–Diagnosis Procedure Combination database (2012.04.01–2022.03.31). SCAD was defined by International Classification of Diseases, 10th revision code I24.8 and the presence of keyword ‘coronary artery dissection’. The primary outcome was in-hospital all-cause mortality. Among 96,304 eligible patients, 330 (0.34%) had SCAD. SCAD patients were younger (P<0.001), more often female (P<0.001), and had fewer atherogenic risk factors. They less frequently received aspirin (P<0.001), angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (P<0.001), statins (P<0.001), and percutaneous coronary intervention (PCI; P<0.001). After propensity score matching, in-hospital all-cause mortality did not differ between SCAD and non-SCAD patients (1.0% vs. 2.9%; P=0.142). The subgroup analysis revealed that the use of aspirin was associated with a lower adjusted in-hospital all-cause mortality (P=0.002), whereas primary PCI (P=0.223), β-blocker (P=0.646), and statin (P=0.608) were not. Of note, older SCAD patients were more likely to exhibit inferior MI (P=0.036 for trend) with shorter duration of hospitalization (P=0.025 for trend).
Conclusions: Short-term outcomes in SCAD patients are comparable with those of atherosclerotic AMI. While aspirin lowered in-hospital mortality, PCI, β-blocker, and statin did not. Our findings suggest the need for physicians to select appropriate therapeutic management in SCAD patients to achieve better outcomes.
