Spontaneous coronary artery dissection cohort study: A nationwide Tunisian series

Authors

  • Selim Boudiche La Rabta Hospital, Tunis, Tunisia
  • Mohamed Chedly La Rabta Hospital, Tunis, Tunisia
  • Mohamed Saadi La Rabta Hospital, Tunis, Tunisia
  • Manel Ben Halima La Rabta Hospital, Tunis, Tunisia
  • Selma Charfeddine Hedi Chaker Hospital, Sfax, Tunisia
  • Leila Abid Hedi Chaker Hospital, Sfax, Tunisia
  • Mehdi Slim Sahloul Hospital, Sousse, Tunisia
  • Elyes Neffati Sahloul Hospital, Sousse, Tunisia
  • Sofien Kamoun Habib Thameur Hospital, Tunis, Tunisia
  • Sondes Kraeim Habib Thameur Hospital, Tunis, Tunisia
  • Faten El Ayech Charles Nicolle Hospital, Tunis, Tunisia
  • Habib Ben Ahmed Charles Nicolle Hospital, Tunis, Tunisia
  • Leila Bezdah Charles Nicolle Hospital, Tunis, Tunisia
  • Fares Azaiez Mongi Slim Hospital, La Marsa, Tunisia
  • Youssef Ben Ameur Mongi Slim Hospital, La Marsa, Tunisia
  • Houssem Ben Ayed Military Hospital of Tunis, Tunis, Tunisia
  • Aymen Noamen Military Hospital of Tunis, Tunis, Tunisia
  • Wafa Fehri Military Hospital of Tunis, Tunis, Tunisia
  • Aymen Ben Abdessalem Farhat Hached Hospital, Sousse, Tunisia
  • Najeh Ben Halima Farhat Hached Hospital, Sousse, Tunisia
  • Abdallah Mahdhaoui Farhat Hached Hospital, Sousse, Tunisia
  • Walid Jomaa Fattouma Bourguiba Hospital, Monastir, Tunisia
  • Khaldoun Ben Hamda Fattouma Bourguiba Hospital, Monastir, Tunisia
  • Lilia Zakhama Internal Security Forces Hospital, La Marsa, Tunisia
  • Rahma Kallel Mohamed Ben Sassi Hospital, Gabes, Tunisia
  • Hichem Denguir Mohamed Ben Sassi Hospital, Gabes, Tunisia
  • Zied Ibn El Hadj Tahar Maamouri Hospital, Nabeul, Tunisia
  • Badi Jedaida Private activity
  • Kais Mrabet Private activity
  • Chiheb Hamza Private activity
  • Karim Bejar Private activity
  • Mehdi Kerkeni Private activity
  • Mohamed Hmem Private activity
  • Kais Battikh Private activity
  • Marouane Boukhris Saint-Etienne Hospital, France
  • Mohamed Sami Mourali La Rabta Hospital, Tunis, Tunisia

DOI:

https://doi.org/10.62438/tunismed.v104i03.6475

Keywords:

Spontaneous coronary artery dissection, Acute coronary syndrome, Pregnancy, Outcome

Abstract

Introduction: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) but remains insufficiently characterized. This study aimed to evaluate early and long-term outcomes of patients with SCAD.
Methods: A national wide, 25-year (since 2000), study with prospective (since 2017) inclusions of patients presenting for ACS with documented SCAD. Primary endpoint was in-hospital and long term major adverse cardiac and cerebrovascular events (MACCE).
Results: 87 patients. Mean age 47.5±11 years, 71% female, 84% had no or only one conventional cardiovascular risk factor. Pregnancy-associated (P-SCAD) accounted for 9%. ST-segment elevation myocardial infarction and cardiogenic shock were described in 51% and 7%. 101 SCAD lesions (60% type 1, 37% type 2 and 3% type 3) were noted. Left anterior descending was the most affected vessel (72%), multivessel involvement was observed in 26% and severe tortuosities were reported in 38%. Conservative strategy was possible in 84% of patients; among them 15% required subsequent urgent clinically driven revascularization. Coronary angiography and percutaneous interventions were associated with five major complications of which one was fatal. Six in-hospital deaths were reported (7%), 4 of them were P-SCAD. After 16-month median follow-up, overall major events and mortality rates were 17% and 9% respectively. Two SCAD recurrences were reported.
Conclusions: SCAD affected a middle-aged, predominantly female population, with no or few conventional risk factors. In-hospital mortality was high especially in P-SCAD. Coronary angiography and interventions for SCAD were associated with frequent complications, and a conservative management should be preferred when possible.

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2026-04-12

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Vol. 104 No. 03 (2026): Tunis Med Mar 2026

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