Contemporary Trends, Outcomes, and Novel Risk Score for Spontaneous Coronary Artery Dissection: A Nationwide Analysis

Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of acute coronary syndrome (ACS). We reviewed the characteristics, predictors, and outcomes of SCAD using the National Inpatient Sample (NIS) database. ACS and SCAD patients were identified from the 2016 to 2020 NIS database. Multivariable logistic regression was performed to identify risk factors associated with SCAD and in-hospital mortality. A risk score model was developed using the 2016 to 2019 cohort and validated with 2020 data. Among 7 219 004 ACS hospitalizations, 30 770 (0.43%) had SCAD (mean age 59.6 years; 58.5% female). Compared with non-SCAD ACS patients, SCAD patients had higher rates of all-cause mortality (8.0% vs 6.0%), and acute stroke (3.2% vs 1.7%). History of percutaneous coronary intervention (3.63 [3.33-3.96]), coronary artery aneurysm (8.87 [5.75-13.70]), and fibromuscular dysplasia (90.50 [69.86-117.25]), all with P < .001, are the strongest predictors of SCAD. Five mortality risk predictors in our risk model were cardiogenic shock, extracorporeal membrane oxygenation, balloon pump, cardiac arrest, and acute kidney injury. The area under the curve for the development and validation datasets was 0.867 and 0.860, respectively. SCAD is a rare but serious form of ACS with distinct risk factors and outcomes. Our risk model may help in early identification and management.