Lack of Association of Spontaneous Coronary Artery Dissection With Autoimmune Disease

Abstract

Background: Case reports and referral-based studies suggest spontaneous coronary artery dissection (SCAD) is associated with autoimmune diseases and causes 2% to 4% of acute coronary syndromes.

Objectives: This study determined the association of SCAD with autoimmune diseases, together with incidence and recurrence, in a population-based study.

Methods: This case-control study took place from 1995 to 2018 within the Rochester Epidemiology Project. The study identified cases with SCAD from diagnosis codes and verified them using coronary angiography images, matching each case to 3 control subjects on age, sex, county, and years of medical history. Autoimmune disease history came from a validated, code-based definition. A multivariable logistic regression model calculated the odds ratio (OR) for SCAD among patients with a history of autoimmune disease, adjusting for race and body mass index.

Results: The study identified 114 cases with SCAD (mean age 51 years and 90% women) and 342 matched control subjects. Autoimmune disease occurred in 13 (11%) cases with SCAD and 40 (12%) control subjects (p = 0.93). Even after adjustment, autoimmune diseases were not associated with SCAD (OR: 0.81; 95% confidence interval [CI]: 0.40 to 1.66). SCAD incidence between 2010 and 2018 (2.7 per 100,000; 95% CI: 1.7 to 3.7) was 10-fold higher than the incidence between 1995 and 2009 (0.3 per 100,000; 95% CI: 0.0 to 0.6). SCAD recurrence was 10% (95% CI: 3% to 16%) at 5 years.

Conclusions: These findings suggested SCAD pathogenesis is noninflammatory and screening for autoimmune diseases based on SCAD alone is not warranted. The code-based incidence of SCAD has increased over time, highlighting the importance of considering SCAD among patients with acute coronary syndromes.

Keywords: autoimmune; incidence; inflammatory; myocardial infarction; recurrence; spontaneous coronary artery dissection.

Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.. Flow diagram of SCAD case identification.

Within the 27-county region of the Rochester Epidemiology Project between 1995 and 2018, we identified 114 unique cases of SCAD.

Figure 2.. SCAD incidence over time.

Age-adjusted SCAD incidence in Olmsted County rose from 1999 to 2018.

Central Illustration.. Summary of Study Findings.

Autoimmune disease prevalence was similar among those with history of SCAD when compared to matched controls.