Interventional Versus Conservative Strategy in Patients With Spontaneous Coronary Artery Dissections: Insights From DISCO Registry
Authors: Benenati Stefano , Giacobbe Federico , Zingarelli Antonio , Macaya Fernando , Biolè Carloalberto , Rossi Angelica , Pavani Marco , Quadri Giorgio , Barbero Umberto , Erriquez Andrea , Aranzulla Tiziana , Cavallino Chiara , Buccheri Dario , Rolfo Cristina , Patti Giuseppe , Gonzalo Nieves , Chinaglia Alessandra , Musumeci Giuseppe , Escaned Javier , Varbella Ferdinando , Cerrato Enrico , Porto Italo , Bianco Matteo , Annibali Gianmarco , Bruno Francesco , D’Ascenzo Fabrizio , Nicolino Annamaria , Bernelli Chiara , Salinas Pablo , Bettari Luca , Bordoni Elisabetta , Infantino Vincenzo , Gambino Alfonso , Rognoni Andrea , Mennuni Marco , Cinconze Sebastian , Boi Alberto , Tomassini Francesco , Franzè Alfonso , Savio Luca Lo , Loi Bruno , Iannaccone Mario , De Benedictis Michele , Campo Gianluca , Ugo Fabrizio , Giachet Alessandra Truffa , Greco Lucchina Giuseppe Pietro , Cassano Francesco , Gagnor Andrea , Beqaraj Federico , Gaido Luca , Perfetti Matteo , Lombardi Primiano 
Published: June 2023

Background:
The optimal management of patients with spontaneous coronary artery dissection remains debated.

Methods:
Patients enrolled in the DISCO (Dissezioni Spontanee Coronariche) Registry up to December 2020 were included. The primary end point was major adverse cardiovascular events, a composite of all-cause death, nonfatal myocardial infarction, and repeat percutaneous coronary intervention (PCI). Independent predictors of PCI and medical management were investigated.

Results:

Among 369 patients, 129 (35%) underwent PCI, whereas 240 (65%) were medically managed. ST-segment–elevation myocardial infarction (68% versus 35%,
P
<0.001), resuscitated cardiac arrest (9% versus 3%,
P
<0.001), proximal coronary segment involvement (32% versus 7%,
P
<0.001), and Thrombolysis in Myocardial Infarction flow 0 to 1 (54% versus 20%,
P
<0.001) were more frequent in the PCI arm. In-hospital event rates were similar. Between patients treated with PCI and medical therapy, there were no differences in terms of major adverse cardiovascular events at 2 years (13.9% versus 11.7%,
P
=0.467), all-cause death (0.7% versus 0.4%,
P
=0.652), myocardial infarction (9.3% versus 8.3%,
P
=0.921) and repeat PCI (12.4% versus 8.7%,
P
=0.229). ST-segment–elevation myocardial infarction at presentation (odds ratio [OR], 3.30 [95% CI, 1.56–7.12];
P
=0.002), proximal coronary segment involvement (OR, 5.43 [95% CI, 1.98–16.45];
P
=0.002), Thrombolysis in Myocardial Infarction flow grade 0 to 1 and 2 (respectively, OR, 3.22 [95% CI, 1.08–9.96];
P
=0.038; and OR, 3.98 [95% CI, 1.38–11.80];
P
=0.009) and luminal narrowing (OR per 5% increase, 1.13 [95% CI, 1.01–1.28];
P
=0.037) were predictors of PCI, whereas the 2B-angiographic subtype predicted medical management (OR, 0.25 [95% CI, 0.07–0.83];
P
=0.026).

Conclusions:
Clinical presentation and procedural variables drive the choice of the initial therapeutic approach in spontaneous coronary artery dissection. If PCI is needed, it seems to be associated with a similar risk of short-to-mid-term adverse events compared to medical treatment.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04415762.