High prevalence of silent aneurysms and fibromuscular dysplasia in spontaneous coronary artery survivors: analysis of the SCAD-POL Registry

EVA was identified in 47.7% of the cohort. The prevalence of FMD was 32.1%, aneurysms were observed in 23.2% of patients, dissections of cervical arteries in 5.5% of patients. 9.3% of patients presented with both FMD and aneurysms. FMD predominantly affected renal (20.3%) and cervical arteries (15.6%), while aneurysms most commonly affected renal and splenic arteries (7.3% each). Multisite FMD was present in 8.3% of patients. 4.6% of subjects had aneurysms in more than one vascular bed. Cervical FMD was associated with migraine headaches in 58.8% of patients and was clinically silent in 41.2% of cases. All aneurysms were silent, however, three patients with intracerebral aneurysms (12%) required intravascular treatment due to risk of rupture. In FMD patients, higher prevalence of type 2a SCAD (65.7 vs. 43.1%, P = 0.03) and pregnancy-associated SCAD (17.6 vs. 4.2%, P = 0.03) was observed. Patients with type 2a SCAD had a 2.5-fold higher likelihood of having FMD (OR 2.53; 95% CI 1.09-5.87, P = 0.03). Conclusions: This study reveals a significant prevalence of EVA in SCAD survivors, with silent aneurysms being more common than previously reported.