Spontaneous Coronary Artery Dissection (SCAD) is a sudden tear in the wall of a coronary artery, which supplies blood to the heart. Unlike typical heart attacks caused by plaque buildup, SCAD is not related to atherosclerosis. A SCAD diagnosis often leads individuals to seek information about their future health, including life expectancy and recovery.
Immediate Survival and Short-Term Outlook
The immediate period after a SCAD event focuses on stabilizing the patient and managing the acute injury. Most individuals who reach the hospital survive the initial event. In-hospital mortality rates for SCAD are low, typically ranging from 1.4% to 3%. This is often due to prompt medical intervention and because SCAD frequently affects younger individuals without widespread atherosclerotic disease.
The initial recovery phase spans a few weeks to several months, focusing on allowing the dissected artery to heal. Many patients are managed conservatively, without invasive procedures, as spontaneous healing of the artery occurs. During this time, individuals may experience lingering symptoms like chest pain, which usually improve as the artery repairs. Close medical monitoring ensures proper healing and addresses ongoing symptoms.
Long-Term Prognosis and Survival Rates
The long-term prognosis for most SCAD survivors is favorable. Studies tracking patients over several years show good survival outcomes. For example, a meta-analysis found a mortality rate of 1% over a mean follow-up of 33 months. Another study reported a 1-year mortality rate of 2.4% and a 10-year mortality rate of 7.7%.
These figures suggest that after the initial event and recovery, many SCAD survivors can expect a life expectancy similar to the general population. A study following patients for a median of 3.1 years reported an overall long-term major adverse cardiac event rate of 19.9%, including a mortality rate of 1.2%. This indicates that SCAD, while serious, does not typically shorten lifespan for most individuals.
Understanding the Risk of Recurrence
A concern for SCAD survivors is the possibility of another event. Recurrence refers to a new tear forming in a coronary artery, not a worsening of the initial dissection. The risk of recurrence varies across studies, with reported rates from 10% to 30% over several years. Some recent prospective studies indicate a lower recurrence rate, with one Canadian cohort reporting a de novo SCAD recurrence rate of 2.4% over three years.
While recurrence is a consideration, most patients do not experience a second SCAD event. The risk of recurrence is higher within the first few months after the initial event and then gradually declines. Close follow-up with healthcare providers is recommended to monitor for new symptoms and manage ongoing health.
Factors Influencing Long-Term Outlook
Several factors influence an individual’s long-term outlook after a SCAD event. Fibromuscular Dysplasia (FMD), a non-atherosclerotic vascular disease that can weaken artery walls, is an underlying condition associated with SCAD. FMD is identified in a substantial proportion of SCAD patients, with prevalence rates from 50% to 86% in systematically screened populations. Its presence can increase the risk of recurrent SCAD and other adverse cardiac events.
Medical management plays a role in influencing the long-term prognosis. Adherence to prescribed medications, such as beta-blockers, reduces the risk of recurrent SCAD by lowering stress on blood vessel walls. Identifying and managing conditions like hypertension is also beneficial, as high blood pressure has been linked to an increased risk of recurrence.
Participating in cardiac rehabilitation programs tailored for SCAD patients is beneficial for recovery and long-term health. These programs provide structured exercise guidance and psychosocial support, addressing physical and emotional aspects of recovery. Adopting heart-healthy lifestyle changes, including moderate physical activity and stress management, complements medical therapy and supports overall well-being after a SCAD diagnosis.