Dang, Quan M

Psaltis, Peter J

Burgess, Sonya

Chandrasekhar, Jaya

Mukherjee, Swati

Kritharides, Leonard

Jepson, Nigel

Fairley, Sarah

Ihdayhid, Abdul

Layland, Jamie

Szirt, Richard

El-Jack, Seif

Puri, Aniket

Davis, Esther

Shiekh, Imran

Arnold, Ruth

Watts, Monique

Marathe, Jessica A

Bhagwandeen, Rohan

Wing-Lun, Edwina

Bhindi, Ravinay

Ford, Tom

Lo, Sidney

Marschner, Simone

Zaman, Sarah

2025-03-07

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS). Recent data suggest a harmful association of dual antiplatelet therapy compared with single antiplatelet therapy following SCAD. This study investigated independent predictors of major adverse cardiovascular events (MACEs) and recurrence in patients with SCAD.This multicentre cohort study involving 23 Australian and New Zealand sites included patients aged ≥18 years with an ACS due to SCAD confirmed on core laboratory adjudication. Multivariable Cox proportional hazard models analysed predictors for the primary MACE outcome.Among 586 patients, 505 (150 prospective, 355 retrospective) with SCAD confirmed by core laboratory adjudication, mean age was 52.2 ± 10.6 years, 88.6% were female, and 74.5% were Caucasian. At long-term follow-up (median 21 months), MACE and SCAD recurrence occurred in 8.6% and 3.6% of patients, respectively. Oral anticoagulation on discharge [adjusted hazard ratio (aHR) 3.8, 95% confidence interval (CI) 1.6-9.3, P = .003], ticagrelor combined with aspirin (aHR 1.8, 95% CI 1.04-3.2, P = .037), fibromuscular dysplasia (aHR 2.2, 95% CI 1.05-4.5, P = .037), and history of stroke (aHR 3.8, 95% CI 1.2-12.2, P = .03) were independently associated with higher MACE. Fibromuscular dysplasia (aHR 3.9, 95% CI 1.5-26.5, P = .01), ticagrelor combined with aspirin (aHR 2.6, 95% CI 2.1-5.3, P = .01), and history of stroke (aHR 6.2, 95% CI 1.8-9.5, P = .01) were also associated with higher SCAD recurrence.The findings support the hypothesis that SCAD is primarily caused by intramural bleeding, with a harmful association of more potent antiplatelet therapy and anticoagulation with adverse cardiovascular outcomes.

Westmead Applied Research Centre, University of Sydney, Sydney, Australia.

Adelaide Medical School, The University of Adelaide, Adelaide, Australia.

Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.

Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.

University of Sydney, Sydney, Australia.

Department of Cardiology, Nepean Hospital, Sydney, Australia.

Department of Cardiology, Box Hill Hospital, Melbourne, Australia.

Eastern Health Clinical School, Monash University, Melbourne, Australia.

Department of Cardiology, Cabrini Hospital, Melbourne, Australia.

ANZAC Medical Research Institute, Sydney, Australia.

Sydney Medical School, University of Sydney, Sydney, Australia.

Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia.

Department of Cardiology, Prince of Wales Hospital, Sydney, Australia.

Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.

Eastern Heart Clinic, Sydney, Australia.

Department of Cardiology, Wellington Hospital, Wellington, New Zealand.

Department of Cardiology, Fiona Stanley Hospital, Perth, Australia.

Harry Perkins Institute of Medical Research, Curtin Medical School, Curtin University, Perth, Australia.

Department of Cardiology, Frankston Hospital, Melbourne, Australia.

Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia.

Department of Cardiology, St George Hospital, Sydney, Australia.

Cardiovascular Unit, North Shore Hospital, Waitemata, New Zealand.

Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.

Victorian Heart Institute, Monash University, Melbourne, Australia.

Department of Cardiology, Victorian Heart Hospital, Melbourne, Australia.

Department of Cardiology, Royal Perth Hospital, Perth, Australia.

Orange Base Hospital, Orange, Australia.

Department of Cardiology, Alfred Hospital, Melbourne, Australia.

University of Melbourne, Melbourne, Australia.

ANZAC Medical Research Institute, Sydney, Australia.

Sydney Medical School, University of Sydney, Sydney, Australia.

Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia.

Cardiology Department, John Hunter Hospital, Newcastle, Australia.

University of Sydney, Sydney, Australia.

Department of Cardiology, Royal Darwin Hospital, Darwin, Australia.

Menzies School of Health Research, Darwin, Australia.

Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.

The University of Newcastle Central Coast Clinical School, Gosford, Australia.

Department of Cardiology, Liverpool Hospital, Sydney, Australia.

Westmead Applied Research Centre, University of Sydney, Sydney, Australia.

Westmead Applied Research Centre, University of Sydney, Sydney, Australia.

Department of Cardiology, Westmead Hospital, Sydney, Australia.

Eur Heart J . 2025 Mar 7:ehaf097. doi: 10.1093/eurheartj/ehaf097. Online ahead of print.

1522-9645

0000-0003-0309-1289

0000-0003-0222-5468

0000-0001-5262-3064

0009-0001-4791-2328

0000-0001-5818-8024

0000-0003-0501-0980

0009-0001-2163-5393

0000-0001-8301-9249

0000-0003-4009-6652

0000-0002-5484-9144

0000-0001-6289-583X

https://pubmed.ncbi.nlm.nih.gov/40049585/?otool=iaurydwlib

https://hdl.handle.net/10137/14175

Acute coronary syndrome

Anticoagulation

Fibromuscular dysplasia

Major adverse cardiovascular event

Myocardial infarction

Recurrence

Spontaneous coronary artery dissection

Ticagrelor

The Australian-New Zealand spontaneous coronary artery dissection cohort study: predictors of major adverse cardiovascular events and recurrence.

Journal Article

Publication