Spontaneous coronary artery dissection cohort study: A nationwide Tunisian series

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Published Apr 12, 2026
https://doi.org/10.62438/tunismed.v104i03.6475
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Vol. 104 No. 03 (2026): Tunis Med Mar 2026

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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

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.

Keywords:

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

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