Health-Related Quality-of-Life and its Determinants After Acute Coronary Syndrome Caused by Spontaneous Coronary...

Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome linked with profound impact on mental health and health-related quality-of-life (HRQoL). This study aimed to explore the determinants of HRQoL for patients with SCAD.

This is a multicentre, prospective cohort study in 23 hospitals across Australia and New Zealand. Patients aged ≥18 years diagnosed with SCAD confirmed on core laboratory adjudication were recruited and gave their informed consent. HRQoL was measured using the European Quality-of-Life 5 Dimensions (EQ-5D) questionnaire at 30 days after the index SCAD event. Beta-regression model was used to explore determinants of HRQoL.

From 2021 to 2025, 193 people with confirmed SCAD were prospectively recruited, with mean age 52.7±10.7 years, 89.1% female, mean body mass index 28.2±6.2 kg/m², and 82.4% White. At least one cardiovascular risk factor was present in 50.8%, with hypertension the most common (30.1%). At a median of 33 days from the index SCAD event, the mean EQ-5D index summary score was 0.77±0.19 and the mean EQ-5D visual analogue scale score was 68.5±17.1. Overall, 43.0% had at least moderate pain/discomfort and 57.0% had at least moderate anxiety or depression. On multivariable analysis, fibromuscular dysplasia (FMD, coefficient -0.25; p=0.005), and female sex (coefficient -0.35; p=0.04) were independently associated with lower QoL scores.

SCAD has a significant impact on the HRQoL of survivors with high rates of pain, anxiety, and depression. Female sex and an FMD diagnosis were independent predictors of lower HRQoL. These findings support the need for FMD and mental health screening and support in SCAD survivors.