Spontaneous Coronary Artery Dissection and Menopause.

Area of Science:

• Cardiology
• Women's Health
• Pathophysiology

Background:

• Spontaneous coronary artery dissection (SCAD) is a significant cause of acute coronary syndrome in women, with hormonal influences suspected in its development.
• Limited data exists on how menopausal status affects SCAD presentation, management, and outcomes in women.

Purpose of the Study:

• To investigate the clinical characteristics, angiographic findings, management strategies, and in-hospital outcomes of SCAD patients stratified by menopausal status.
• To identify differences in SCAD presentation between pre-menopausal and post-menopausal women.

Main Methods:

• Analysis of data from the Spanish multicenter prospective SCAD registry (NCT03607981), including 245 women classified as pre-menopausal or post-menopausal.
• Centralized core laboratory analysis of all coronary angiograms.
• Comparison of in-hospital outcomes, clinical data, and angiographic features between the two menopausal groups.

Main Results:

• Post-menopausal SCAD patients were older, with higher rates of hypertension and dyslipidemia, and a history of prior acute coronary syndrome, including SCAD.
• Premenopausal women more frequently exhibited proximal and multi-segment coronary artery involvement and presented more often with ST-segment elevation myocardial infarction.
• Conservative management was more common in post-menopausal women, who also had less frequent left ventricular dysfunction; however, in-hospital outcomes like mortality and length of stay did not differ between groups.

Conclusions:

• Menopausal status is associated with distinct clinical and angiographic profiles in women experiencing SCAD.
• Despite differing initial management approaches, in-hospital outcomes for spontaneous coronary artery dissection are comparable between pre-menopausal and post-menopausal women.