Adherence to consensus recommendations in the care of patients with spontaneous coronary artery dissection from the ANZ-SCAD registry

Background Spontaneous Coronary Artery Dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS). In 2018, the American Heart Association and the European Society of Cardiology published the first consensus documents guiding the care of SCAD with four key recommendations: administration of at least one antiplatelet, beta-blocker use, screening for fibromuscular dysplasia (FMD), and referral for cardiac rehabilitation. Purposed We aimed to assess adherence to quality-of-care recommendations for patients with SCAD according to the consensus guidelines and changes in practice over time. Methods Multi-centre cohort study conducted in 23 hospitals across Australia and New Zealand from 2009 to 2024. Patients >18 years of age with an ACS and SCAD confirmed on core laboratory adjudication of invasive coronary angiography were included. Multivariate logistic regression model assessed changes in care over time, with adjustment for age, sex, type of ACS, percutaneous coronary intervention (PCI), left ventricular (LV) function and history of hypertension. Results A total of 576 patients with core laboratory confirmed SCAD were included, mean age 52.0±10.5, 89.1% female, 29.1% hypertension, 66.7% Non-ST elevation ACS and 33.3% ST elevation ACS. A total of 10.9% received PCI and LV impairment occurred in 9.3%. Overall, 95.4% of patients received at least one antiplatelet agent, 80.8% a beta-blocker, 47.8% screened for FMD, 76.0% referred to cardiac rehabilitation and 33.3% received all four recommendations. After controlling for potential confounders, the proportion of patients with SCAD who received at least one antiplatelet reduced over time (adjusted odds ratio [aOR] 0.69, 95% confidence interval [CI] 0.51-0.89). Beta-blocker use was unchanged over time (aOR 1.08, 95%CI 0.99-1.17) while FMD screening (OR 1.27, 95%CI 1.14-1.42) and cardiac rehabilitation referral (aOR 1.14, 95%CI 1.07-1.23) significantly increased. Conclusion A low proportion of Australian and New Zealand patients with SCAD received recommended care, with particularly low rates of FMD screening. However, significant improvements in FMD screening and cardiac rehabilitation referral were seen over time.