Spontaneous Coronary Artery Dissection in Highly Active Individuals: Insights From a Prospective Registry

Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of acute coronary syndrome that disproportionately affects young, healthy women. While physical exertion has been implicated as a potential trigger, the clinical characteristics of highly active individuals (HAIs) with SCAD remain poorly understood.

The purpose of this study was to compare patient characteristics, SCAD presentation and management, and SCAD recurrence rates between HAIs and non-HAIs using data from a large, prospective SCAD registry.

We analyzed 833 participants with angiographically confirmed SCAD from the Mayo Clinic SCAD "Virtual" Multi-Center Registry who completed vital components of a supplemental survey. HAIs were defined as individuals participating in competitive or structured physical activity ≥30 min/d, ≥5 d/wk for ≥12 months. Characteristics and outcomes were compared between HAIs (n = 245) and non-HAIs (n = 588).

HAIs had a lower prevalence of hypertension, smoking, and lower body mass index. HAIs were more likely to present with non-ST-segment elevation myocardial infarction and cardiac arrest with initial SCAD event, and less likely with ST-segment elevation myocardial infarction, multivessel or left main SCAD, or pregnancy-associated SCAD. Exercise-related SCAD was much more common in HAIs, present in 44.5% vs 28.2% of non-HAIs (P < 0.001). Among HAIs, 2.9% experienced an out-of-hospital cardiac arrest in association with exercise, compared to 0.7% of non-HAIs (P = 0.012). Recurrent SCAD and major adverse cardiac events did not differ between groups.

HAIs with SCAD demonstrate a distinct clinical profile which may represent a unique phenotype. HAIs with SCAD were not at higher risk of recurrence or major adverse cardiac event at 10-year follow-up.