Interventional Cardiology Fellow University of Ottawa Heart Institute University of Ottawa Heart Institute Montréal, Quebec, Canada
Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome that disproportionately affects younger females, yet sex-differences in clinical presentation, management, and outcomes of SCAD remain poorly understood. We aimed to examine sex-based disparities in clinical features, management, and outcomes in SCAD patients included in the MINDSET (Measuring Insights, Needs and Emotions) study.
METHODS AND RESULTS: The MINDSET study was a multi-site, cross-sectional, observational study which primary aim was to describe the psychological profile and intervention needs of SCAD patients SCAD. Patients with an angiographic diagnosis of SCAD within 3 years were recruited from 7 cardiac care hospitals across Canada. Medical information was obtained from chart review. Two-group comparison of clinical presentation, management, and outcomes were performed according to sex, using a student t-test for continuous measures and Chi-squared test for categorical variables. A total of 309 females and 23 males were included, with a mean age of 53.5 and 50.5 years, respectively. Clinical and demographic characteristics of patients were similar across sex, except for a higher prevalence of previous coronary artery disease in males (26.0% female vs. 52.2% male; p<.01) and migraines in females (23.6% female vs. 4.4% male; p=.03) (Table 1). SCAD predisposing conditions and precipitating factors were comparable between sexes, apart from intense physical activity which trended to be more frequent in males (30.4% male vs. 15.5% female; p=.06). Clinical presentation varied between sexes (Table 2): males were more likely to present with STEMI (34.8% male vs. 29.8% female) or ventricular arrythmia (8.7% male vs. 0.1% female), while NSTEMI was more common in females (66.4% female vs. 52.2% male) (p <.01). Procedural characteristics were largely similar, except for differences in the culprit artery (p=.04): females more frequently had left anterior descending/branch (40.7% female vs. 30.4 % male), circumflex/branch (19.9% female vs. 17.4% male) or multivessel SCAD (12.3% female vs. 0.0% male). Initial management strategies were comparable (p=.90), with most patients receiving conservative treatment (84.0% female vs. 90.0% male). Medical therapy received was similar across sex (ASA 87.7% vs. 82.6%; P2Y12 inhibitor 25.0% vs. 21.7%; beta-blockers 39.8% vs. 56.5% in females and males, respectively). There were no sex differences in the rate of SCAD extension (6.9% female vs. 0.0% male; p=.42) or recurrence (6.9% female vs. 0.0% male; p=.18).
Conclusion: While the results highlight the need to recognize sex-specific factors in clinical presentation of SCAD, the effectiveness of current treatment strategies was equivalent across all patients.
