Sex Differences in Spontaneous Coronary Artery Dissection: A Report of the iSCAD Registry
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Spontaneous coronary artery dissection is a cause of myocardial infarction, which predominantly affects middle‐aged women. There are limited data on men with spontaneous coronary artery dissection. Methods Information on demographics, presenting characteristics, in‐hospital outcomes including major adverse cardiovascular events (composite of myocardial infarction, cerebrovascular accident, or heart failure), length of stay, and discharge medications in men and women were obtained from the multicenter iSCAD (International Spontaneous Coronary Artery Dissection) registry. Results Of 1252 patients enrolled from 2019 to 2023, 80 (6.4%) were men. Mean age did not significantly differ between sexes (men, 50.2±10.3 versus women 49.7±10.4; P =0.792). Women reported more emotional stress preceding spontaneous coronary artery dissection (10.2% versus 2.5% men; P =0.025). Men reported more physical stress (22.5% versus 7.7% women; P <0.001), both isometric exertion (12.5% versus 2.4% women; P <0.001) and aerobic exertion (12.5% versus 5.6% women, P <0.013). Chest discomfort was the major symptom, although women reported more non–chest discomfort, shortness of breath, and nausea/vomiting. Men had fewer autoimmune conditions, systemic inflammatory disorders, and fibromuscular dysplasia but more recreational drug use. In‐hospital major adverse cardiovascular events did not significantly differ (4.1% men versus 8.5% women; P =0.178). The median length of stay was 3.0 (interquartile range, 3.0–4.0) days for males versus 4.0 (interquartile range, 3.0–5.0) days for women ( P =0.003). At discharge, more men were prescribed statins (72.5% men versus 55.3% women; P =0.003) and dual antiplatelet therapy (66.3% men versus 53.7% women) ( P =0.049). Conclusions In a large spontaneous coronary artery dissection registry, there were significant sex differences in presentation, baseline medical conditions, and triggers. In‐hospital outcomes were similar, but length of stay was longer for women. Men were more often discharged on statins and dual antiplatelet therapy.
Authors: Lori M. Tam, Sahar Naderi, Gerald Chi, Heather L. Gornik, Bryan J. Wells, Daniella Kadian‐Dodov, Anna Grodzinsky, Angela M. Taylor, Connie N. Hess, Jennifer Lewey, Stanislav Henkin, James L. Orford, Kathryn J. Lindley, Gretchen L. Wells, Rina Mauricio, Michelle L. Ouellette, Jeffrey Trost, Agnes Koczo, Stephanie Saucier, Daniela R. Crousillat, Sonia Tolani, Jason C. Kovacic, C. Michael Gibson, Katherine K. Leon, Malissa J. Wood, Esther S.H. Kim
Institutions: Kaiser Permanente Northern California, Beth Israel Deaconess Medical Center, Emory University, Icahn School of Medicine at Mount Sinai, University of Missouri–Kansas City, University of Virginia Medical Center, University of Colorado Anschutz, University of Colorado Denver, University of Pennsylvania, Dartmouth–Hitchcock Medical Center, Intermountain Healthcare, Intermountain Medical Center, Vanderbilt University Medical Center, University of Kentucky, The University of Texas Southwestern Medical Center, Johns Hopkins University, University of Pittsburgh Medical Center, Hartford Hospital, University of South Florida, NewYork–Presbyterian Hospital, Columbia University Irving Medical Center, UNSW Sydney
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
OpenAlex ID: W7124176196