P062 - DEMOGRAPHIC, CLINICAL PRESENTATION AND MANAGEMENT OF PATIENTS WITH SPONTANEOUS CORONARY ARTERY DISSECTION WITH AND WITHOUT FIBROMUSCULAR DYSPLASIA

Background: Fibromuscular dysplasia (FMD) has been associated with spontaneous coronary artery dissection (SCAD), and is tied to worse long-term outcomes. However, how FMD impacts clinical features and management of SCAD remains poorly understood. The purpose of this study was to examine differences in clinical features, and management in SCAD patients with and without FMD included in the MINDSET (Measuring Insights, Needs and Emotions) study.

METHODS AND RESULTS: The MINDSET study was a multi-site, cross-sectional, observational study of patients diagnosed with SCAD (via angiography) in the past 3 years recruited from 7 Canadian cardiac care hospitals. Medical information was obtained from chart review. Two-group comparisons of demographic, clinical presentation and management were performed according to presence of FMD or not, using a student t-test for continuous measures and Chi-Square test for nominal variables. From the 326 patients recruited in MINDSET, 322 (98.8%) patients underwent FMD screening, from whom 296 (90.8%) and 26 (8.0%) patients had available and pending FMD screening results, respectively. From the 296 SCAD patients retained in the analysis, 128 (43.2%) had FMD. Clinical and demographic characteristics were similar (Table 1), except FMD patients were more likely to be older (54.9  9.9 years vs. 51.7  12.0 years no-FMD; p=.02), female (98.4% vs. 89.3% no-FMD ; p<.01), have a previous history of migraines (21.1% vs. 11.9% no-FMD; p=.03), and less likely to have a previous history of coronary artery disease (18.8% vs. 31.0% no-FMD; p=.02). SCAD predisposing conditions and precipitating factors were similar, except intense emotional stress being a more frequent in FMD patients (39.8% vs. 28.6% no-FMD; p=.04). Clinical presentation, procedural characteristics and initial management strategy were similar (Table 2), with most patients being treated conservatively (83.3% vs. 81.3% no-FMD; p=.63). Medical therapy received was similar (ASA 93.6% vs. 89.1%, p=.18; beta-blockers 95.3% vs. 91.0%, p=.16 in FMD vs. no-FMD, respectively).

Conclusion: While the results highlight the need to recognize factors specific to FMD in demographic and clinical characteristics, current treatment strategies were equivalent across all patients.