Prognostic Value of Cardiac MRI for Acute Spontaneous Coronary Artery Dissection: A Prospective Cohort Study

Purpose To determine whether baseline clinical characteristics and cardiac MRI parameters predict major adverse cardiac events (MACEs) in participants with angiographically confirmed spontaneous coronary artery dissection (SCAD). Materials and Methods This prospective single-center study included participants with SCAD who were angiographically diagnosed between March 2018 and November 2023. Cardiac MRI was performed after a median of 4 days (IQR, 1.5-7) from symptom onset. SCAD types were classified according to the Yip-Saw system. Follow-up evaluation was performed at a median of 5.5 months after discharge, and MACEs were recorded. The primary outcome was the occurrence of MACEs. Secondary analyses included extent of late gadolinium enhancement (LGE). Statistical analysis included binary logistic and Cox proportional hazards regression. Results Overall, 59 participants (mean age, 49 years ± 10; 40 female participants [68%]) were included. ST-elevation myocardial infarction at presentation was diagnosed in 24 of 59 (41%). Angiographically, 41 of 59 (69.5%) were SCAD type 2. Baseline cardiac MRI demonstrated acute injury in 48 of 59 (81%) and LGE in 54 of 59 (93%), typically moderate (median, three segments [IQR, two to five]). In the adjusted model, ST-elevation myocardial infarction manifestation independently predicted greater LGE extent (<i>P</i> = .02; odds ratio, 7.00; 95% CI: 2.00, 24.00). After multivariable adjustment, SCAD type 1 was significantly associated with MACEs (<i>P</i> = .002; hazard ratio, 10.00; 95% CI: 2.00, 23.00), as was transmural LGE (<i>P</i> = .006; hazard ratio, 1.50; 95% CI: 1.10, 2.10). A threshold of greater than or equal to four LGE segments identified a critical risk zone. Conclusion In SCAD, SCAD type 1 and involvement of more than three transmural LGE segments at acute cardiac MRI independently predicted MACEs. <b>Keywords:</b> MR Perfusion, Cardiac, Arteries, Cardiomyopathies, Ischemia/Infarction <i>Supplemental material is available for this article.</i> © RSNA, 2026.