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An in-depth analysis of coronary computed tomography angiography segmental findings in acute spontaneous coronary artery dissection – a prospective multicenter study

Pagonis, Christos ; Sandstedt, Mårten ; Dworeck, Christian ; Fagman, Erika ; Erlinge, David LU orcid ; Adlam, David ; Andersson, Jonas ; Fredriksson, Mats ; Glaser, Natalie and Henriksson, Lilian , et al. (2025) In Journal of Cardiovascular Computed Tomography 19(5). p.559-567
Abstract

Aims: Spontaneous coronary artery dissection (SCAD), causing acute coronary syndrome (ACS), primarily in middle-aged women, is diagnosed with invasive coronary angiography (ICA). Due to the risk of dissection propagation with ICA, a non-invasive diagnostic tool is needed. We investigated coronary computed tomography angiography (CCTA) findings in acute SCAD, as well as the inter-modality agreement between CCTA and ICA. Methods and results: Thirty-two (92 ​% women, mean age 52.4 years) SCAD patients at eight Swedish hospitals were investigated with ICA as well as dual source CCTA during the index hospitalisation between April 2021 and October 2022. ICA identified 46 dissected segments whereas CCTA detected 25, Cohen's kappa (κ) ​= ​0.595... (More)

Aims: Spontaneous coronary artery dissection (SCAD), causing acute coronary syndrome (ACS), primarily in middle-aged women, is diagnosed with invasive coronary angiography (ICA). Due to the risk of dissection propagation with ICA, a non-invasive diagnostic tool is needed. We investigated coronary computed tomography angiography (CCTA) findings in acute SCAD, as well as the inter-modality agreement between CCTA and ICA. Methods and results: Thirty-two (92 ​% women, mean age 52.4 years) SCAD patients at eight Swedish hospitals were investigated with ICA as well as dual source CCTA during the index hospitalisation between April 2021 and October 2022. ICA identified 46 dissected segments whereas CCTA detected 25, Cohen's kappa (κ) ​= ​0.595 (95 ​% confidence interval [CI] 0.46–0.73). CCTA primary and secondary features were identified in 24 dissected coronary artery segments in 21 patients, 8 (32 ​%) tapered luminal stenosis, 11 (44 ​%) abrupt luminal stenosis, 3 (12 ​%) visible dissection membrane, 4 (16 ​%) intramural-hematomas, 9 (36 ​%) epicardial fat stranding and 8 (25 ​%) with coronary artery tortuosity. ICA identified 3 dissected proximal segments whereas CCTA identified 5, (κ ​= ​0.74, 95 ​% CI 0.40–1.00). In distal segments, ICA identified 43 and CCTA 20 dissections, (κ ​= ​0.57, 95 ​% CI 0.43–0.72). Conclusions: In patients presenting with acute SCAD, CCTA should not be considered a substitute for ICA. While CCTA demonstrated good diagnostic performance in identifying proximal SCAD lesions, its sensitivity was notably reduced in distal coronary segments, where SCAD is more frequent. Among the 25 lesions detected, CCTA successfully detected specific features in 24 lesions.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute coronary syndrome, Coronary angiography, Coronary computed tomography angiography, Myocardial infarction, Spontaneous coronary artery dissection
in
Journal of Cardiovascular Computed Tomography
volume
19
issue
5
pages
9 pages
publisher
Elsevier
external identifiers
  • scopus:105014292169
  • pmid:40877057
ISSN
1934-5925
DOI
10.1016/j.jcct.2025.08.002
language
English
LU publication?
yes
id
49e8cedc-3755-4a2c-b557-24f413a3f3a0
date added to LUP
2025-11-17 12:32:28
date last changed
2025-11-17 12:33:40
@article{49e8cedc-3755-4a2c-b557-24f413a3f3a0,
  abstract     = {{<p>Aims: Spontaneous coronary artery dissection (SCAD), causing acute coronary syndrome (ACS), primarily in middle-aged women, is diagnosed with invasive coronary angiography (ICA). Due to the risk of dissection propagation with ICA, a non-invasive diagnostic tool is needed. We investigated coronary computed tomography angiography (CCTA) findings in acute SCAD, as well as the inter-modality agreement between CCTA and ICA. Methods and results: Thirty-two (92 ​% women, mean age 52.4 years) SCAD patients at eight Swedish hospitals were investigated with ICA as well as dual source CCTA during the index hospitalisation between April 2021 and October 2022. ICA identified 46 dissected segments whereas CCTA detected 25, Cohen's kappa (κ) ​= ​0.595 (95 ​% confidence interval [CI] 0.46–0.73). CCTA primary and secondary features were identified in 24 dissected coronary artery segments in 21 patients, 8 (32 ​%) tapered luminal stenosis, 11 (44 ​%) abrupt luminal stenosis, 3 (12 ​%) visible dissection membrane, 4 (16 ​%) intramural-hematomas, 9 (36 ​%) epicardial fat stranding and 8 (25 ​%) with coronary artery tortuosity. ICA identified 3 dissected proximal segments whereas CCTA identified 5, (κ ​= ​0.74, 95 ​% CI 0.40–1.00). In distal segments, ICA identified 43 and CCTA 20 dissections, (κ ​= ​0.57, 95 ​% CI 0.43–0.72). Conclusions: In patients presenting with acute SCAD, CCTA should not be considered a substitute for ICA. While CCTA demonstrated good diagnostic performance in identifying proximal SCAD lesions, its sensitivity was notably reduced in distal coronary segments, where SCAD is more frequent. Among the 25 lesions detected, CCTA successfully detected specific features in 24 lesions.</p>}},
  author       = {{Pagonis, Christos and Sandstedt, Mårten and Dworeck, Christian and Fagman, Erika and Erlinge, David and Adlam, David and Andersson, Jonas and Fredriksson, Mats and Glaser, Natalie and Henriksson, Lilian and Johnston, Nina and Henareh, Loghman and Markstad, Hanna and Ostenfeld, Ellen and Tornvall, Per and Venetsanos, Dimitrios and Welén-Schef, Kerstin and Yndigegn, Troels and Swahn, Eva and Sederholm Lawesson, Sofia}},
  issn         = {{1934-5925}},
  keywords     = {{Acute coronary syndrome; Coronary angiography; Coronary computed tomography angiography; Myocardial infarction; Spontaneous coronary artery dissection}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{559--567}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Cardiovascular Computed Tomography}},
  title        = {{An in-depth analysis of coronary computed tomography angiography segmental findings in acute spontaneous coronary artery dissection – a prospective multicenter study}},
  url          = {{http://dx.doi.org/10.1016/j.jcct.2025.08.002}},
  doi          = {{10.1016/j.jcct.2025.08.002}},
  volume       = {{19}},
  year         = {{2025}},
}