CONGRESS ABSTRACT

Background. Spontaneous Coronary Artery Dissection (SCAD) is a cause of acute coronary syndrome (ACS), predominantly affecting young women. Optimal management of SCAD, particularly concerning revascularization versus conservative therapy, and the role of pharmacological treatments remains unclear.  Aims. To further investigate the diagnosis and management of this condition and to assess the acute and long-term outcomes in a local real world experience in Lombardia. Methods and results. We retrospectively examined clinical characteristics, management, and long-term outcomes of 25 SCAD patients presented with ACS at Pio XI Hospital in Lombardia, Italy, between 2008 and 2024. The majority of patients (76%) were women, with a median age of 52.1 years. Type 2 SCAD was the most common type at angiography (72%), mostly affecting mid-to-distal coronary artery segments. 68% of patients were managed conservatively, 32% underwent percutaneous coronary intervention (PCI). Only 37.5% were successful procedures. 80% of patients received empirical dual antiplatelet therapy (DAPT) with very varying indications for P2Y12 inhibitors type and duration. Major adverse cardiovascular and cerebrovascular events (MACCE) occurred with a rate of 0.08% per patient-year over a median follow-up of 2.6 years.  Female sex, PCI and proximal vessels were associated with a higher rate of MACCE. Beta-blockers associated with a lower MACCE incidence rate. Conclusions. SCAD is a cause of ACS to be considered especially in young women, generally associated to favorable prognosis.  We found that PCI is associated to low procedural success and higher rates of long-term MACCE, such as proximal vessels involvement and female sex, supporting current expert guidelines recommendation for conservative therapy as the first-line treatment. The use of DAPT and its duration remains controversial, while use of beta-blockers could have a protective role. Further perspective studies are needed to better define acute and follow-up management of these patients and to guide specific departmental and/or national guidelines.