Spontaneous Coronary Artery Dissection: Does The Trigger Matter? Insights From The G-scad Registry

Background
Spontaneous coronary artery dissection (SCAD) is emerging as an important cause of acute coronary syndrome. The triggers for SCAD often do not include traditional atherosclerotic risk factors. The most commonly reported trigger is stress. This study compared short-term and long-term outcomes in patients with SCAD in the presence or absence of identified stress.

Methods
Data from 131 patients with a confirmed diagnosis of SCAD were collected retrospectively from 30 centers in 4 gulf countries (KSA, UAE, Kuwait and Bahrain) from January 2011 to December 2017. Short-term (VT/VF, cardiogenic shock, MI, death, dissection extension, PCI, ICD placement) and long-term (VT/VF, death, MI, de novo SCAD) outcomes were compared between those with and without stress. Emotional stress was defined as experiencing major stress prior to hospital admission and categorized as severity level ≥3 on a 4-point scale. Physical stress was defined as new or unusually intense physical exercise or intense isometric activity defined as lifting more than 50 pounds prior to hospitalization.

Results
Mean age was 49 years. 46 (35%) were women. Stress (emotional, physical or both) was reported in 78 (60%) of all patients. 70% of women and 54% of men with SCAD had stress. Men had significantly more physical and combined stress than women who had more emotional stress (P<0.0001). The presence or absence of identified stress did not impact patient outcomes (P=0.12).

Conclusions
Overall, short-term and long-term outcomes were comparable in patients with SCAD in the presence or absence of identified stress as a trigger.