BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an important but under-recognised cause of acute coronary syndrome (ACS). In 2018, the American Heart Association and the European Society of Cardiology published the first consensus documents that recommended the following for patients with SCAD: at least single antiplatelet therapy, beta-blocker therapy, fibromuscular dysplasia (FMD) screening, and cardiac rehabilitation.
AIM: We aimed to assess adherence to key quality-of-care recommendations for SCAD survivors and changes in practice over time.
METHOD: A 23-hospital multicentre cohort study in Australia and New Zealand from 2010 to 2024 included patients aged 18 years and older with an ACS and SCAD confirmed on core laboratory adjudication of invasive coronary angiography. Logistic regression analysis with adjustment for age, sex, type of ACS, percutaneous coronary intervention, left ventricular function, and hypertension was used to assess changes in care over time.
RESULTS: A total of 567 patients with core laboratory-confirmed SCAD were included, mean age 52.0±10.5, 89.1% female, 66.7% non-ST elevation ACS, 33.3% ST elevation ACS, and 10.9% received percutaneous coronary intervention. Overall, 95.4% of patients received at least one antiplatelet agent, 80.8% were on beta-blocker therapy, 47.8% were screened for FMD, 76.0% were referred to cardiac rehabilitation, and 33.3% received all four recommendations. On multivariable logistic regression modelling, the proportion of SCAD survivors who received at least one antiplatelet reduced over time (adjusted odds ratio [aOR] 0.69; 95% confidence interval [CI] 0.51-0.89), beta-blocker therapy was unchanged (aOR 1.08; 95% CI 0.99-1.18), and FMD screening (aOR 1.24; 95% CI 1.13-1.30) and cardiac rehabilitation referral (aOR 1.16; 95% CI 1.07-1.25) significantly increased.
CONCLUSIONS: A low proportion of Australian and New Zealand patients with SCAD received all recommended care, with particularly low rates of FMD screening. Significant improvements in FMD screening and cardiac rehabilitation referral were seen over time, but this did not apply to antiplatelet therapy.