Abstract
AIM: Spontaneous Coronary Artery Disease (SCAD) is a rare condition that mimics acute coronary syndrome and can lead to serious complications. This study evaluates SCAD characteristics, Major Adverse Cardiac Event (MACE) predictors, revascularization needs, and treatment outcomes. MATERIALS AND METHODS: The single cardiac center, retrospective cohort study analyzed patients diagnosed with coronary artery dissection during coronary angiography between January 2014 and December 2019. RESULTS: Of 86 patients, 24(27.9%) experienced early MACE. Diffuse dissections (62.5% vs. 37.5%, p = 0.027) and ostium-involving dissections (33.3% vs. 8.1%, p = 0.006) were more frequent in the MACE group. Female patients (58.3% vs. 21.0%, p = 0.001) and those with lower pre-procedural ejection fraction (EF) (44.1 ± 13.5 vs. 55.0 ± 8.8, p = 0.004) or higher neutrophil to lymphocyte ratio (NLR) (5.59 ± 3.67 vs. 3.60 ± 2.46, p = 0.005) had a higher risk. Ostium-involving dissections (OR(Odds Ratio) = 9.41, p = 0.024) and low EF (OR = 0.931, p = 0.040) were independent predictors of MACE. Initial medical treatment is associated with higher unplanned revascularization compared to percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) (p = 0.030). Coronary tortuosity (p = 0.006) and spot lesions (p = 0.005) were associated with late revascularization. CONCLUSION: High early MACE after SCAD is associated with female gender, high NLR, and low EF. Diffuse and ostium-involving dissections significantly increase the risk of MACE. Initial treatment has been shown to influence early revascularization. while coronary features like tortuosity predict long-term outcomes. CLINICAL TRIAL NUMBER: Not applicable.