Sex Differences in Spontaneous Coronary Artery Dissection: A Report of the iSCAD Registry

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.

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.

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).

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.