Introduction
Spontaneous coronary artery dissection (SCAD) predominantly affects females with limited data on outcomes in males.
Aim
We aimed to determine sex differences in presentation, associated conditions and major adverse cardiovascular events (MACE) in SCAD.
Method
This multicentre cohort study recruited patients with core-laboratory confirmed SCAD from 23 Australian/New Zealand sites. Sex differences were analysed using descriptive statistics. A cox proportional hazards model assessed predictors of MACE, with interaction analysis determining the impact of sex.
Results
527 patients with SCAD were included: 468 (88.8%) female, mean age 53.5±10.6 years. Females had higher aspirin use at baseline (10% versus 1.7%, p=0.031) and hypertension (30.6% versus 16.9%, p=0.044), compared to males. Emotional stress as a SCAD precipitant was documented in more females (16.0% versus 2.9% males, p=0.042) with no difference when self-reported (60.6% females versus 54.2% males, p=0.715). Fibromuscular dysplasia (FMD) was detected in 24.2% versus 16.7% (p=0.612) and non-FMD vascular abnormalities in 4.0% versus 16.7% (p=0.027) of females versus males screened. There was no sex difference in 3-year MACE; 8.2% females, 12.1% males (log-rank p=0.2) (Figure 1). On multivariable analysis, oral anticoagulation, dual antiplatelet therapy (DAPT) comprising aspirin and ticagrelor, FMD and previous stroke were associated with higher MACE, with no significant interaction by sex (all p-values >0.05).
Conclusion
Females with SCAD had higher rates of hypertension, while males had more non-FMD vascular abnormalities. Self-reported emotional stress was common and equally prevalent in both sexes. Anticoagulation, DAPT comprising aspirin and ticagrelor, FMD and previous stroke were independent predictors of MACE with no sex difference.