{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:46:48Z","timestamp":1791582408550,"version":"4.3.4"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,5,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The goal of this study is to report the characteristics and long\u2010term clinical outcomes of patients with spontaneous coronary artery dissection (SCAD) and to identify factors associated with recurrent\n              <jats:styled-content style=\"fixed-case\">SCAD<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This is a retrospective cohort study that included patients who underwent coronary angiography for evaluation of acute myocardial infarction between 2006 and 2016. Among 26\u00a0598 patients hospitalized with a principal diagnosis of acute myocardial infarction, 208 (0.78%) were diagnosed with\n              <jats:styled-content style=\"fixed-case\">SCAD<\/jats:styled-content>\n              . Patients with\n              <jats:styled-content style=\"fixed-case\">SCAD<\/jats:styled-content>\n              were younger (49.0\u00b111.6 versus 65.6\u00b112.2\u00a0years) and more likely to be women (88.9% versus 31.6%). Atherosclerotic risk factors, such as hypertension, hyperlipidemia, obesity, and diabetes mellitus, were less prevalent. Median follow\u2010up was 4.7\u00a0years. Mortality was lower in patients with SCAD (1\u2010year mortality: 2.4% versus 8.8%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). After using propensity score matching to control for differences in age, sex, and comorbidities, the difference in mortality was no longer present, suggesting that lower mortality in patients with SCAD is attributed primarily to their baseline characteristics. Recurrent\n              <jats:styled-content style=\"fixed-case\">SCAD<\/jats:styled-content>\n              occurred in 22 patients (10.6%). Multivariate Cox regression modeling showed concomitant fibromuscular dysplasia (hazard ratio, 5.1; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 1.6\u201315.8;\n              <jats:italic>P<\/jats:italic>\n              =0.005) and migraine headaches (hazard ratio, 3.4; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 1.4\u20138.4;\n              <jats:italic>P<\/jats:italic>\n              =0.008) to be associated with increased risk of recurrent\n              <jats:styled-content style=\"fixed-case\">SCAD<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Among patients with acute myocardial infarction, patients with\n              <jats:styled-content style=\"fixed-case\">SCAD<\/jats:styled-content>\n              have a lower risk of mortality, which is attributed primarily to their younger age, female sex, and low prevalence of atherosclerotic risk factors. Risk of recurrent\n              <jats:styled-content style=\"fixed-case\">SCAD<\/jats:styled-content>\n              persists years after the initial presentation. Patients with fibromuscular dysplasia and migraine are at higher risk for recurrent\n              <jats:styled-content style=\"fixed-case\">SCAD<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.012570","type":"journal-article","created":{"date-parts":[[2019,5,14]],"date-time":"2019-05-14T09:00:23Z","timestamp":1557824423000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":124,"title":["Characteristics and Clinical Outcomes of Patients With Spontaneous Coronary Artery Dissection"],"prefix":"10.1161","volume":"8","author":[{"given":"Ryan","family":"Clare","sequence":"first","affiliation":[{"name":"Department of Cardiology Kaiser Permanente Los Angeles Medical Center Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewei","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation Kaiser 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CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert Y.","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kaiser Permanente Los Angeles Medical Center Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming\u2010Sum","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kaiser Permanente Los Angeles Medical Center Los Angeles 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