Key result
Dual antiplatelet therapy was associated with a higher incidence of major adverse cardiovascular events compared to single antiplatelet therapy in conservatively managed SCAD (21.9% vs 0%, p=0.016).
Why the study?
The optimal antiplatelet regimen for conservatively managed spontaneous coronary artery dissection remains unclear, with limited evidence supporting routine dual antiplatelet therapy.
Does dual antiplatelet therapy reduce major adverse cardiovascular events in patients with conservatively managed spontaneous coronary artery dissection compared to single antiplatelet therapy?
Cohort (n=57)
Does dual antiplatelet therapy reduce major adverse cardiovascular events in patients with conservatively managed spontaneous coronary artery dissection compared to single antiplatelet therapy?
Answers are grounded in this paper and cite their sources.
In patients with conservatively managed SCAD, dual antiplatelet therapy was associated with a higher incidence of MACE compared to single antiplatelet therapy, suggesting it may not confer benefit and could be detrimental.
Background Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndromes, predominantly affecting young to middle-aged women without conventional atherosclerotic risk factors. The optimal antiplatelet regimen for conservatively managed SCAD remains unclear, with limited evidence to support the routine use of dual antiplatelet therapy (DAPT). Purpose To compare clinical outcomes between patients discharged on single antiplatelet therapy (SAPT) and those on dual antiplatelet therapy (DAPT) following conservatively managed SCAD. Methods We retrospectively analyzed patients with angiographically confirmed SCAD who were managed conservatively between November 2009 and August 2025. Demographic, clinical, angiographic and follow-up data were collected and analyzed. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular death, myocardial infarction, stroke or hospitalization for heart failure. Continuous variables are expressed as median and interquartile range (IQR). Results A total of 57 patients were included; 94.8% were women, with a median age of 52.5 years (IQR 45.5–64.25). Twenty-five (43.9%) were discharged on SAPT and 32 (56.1%) on DAPT. DAPT was more frequently prescribed in patients with angiographic type 1 dissections (71.4% vs. 28.6%, p = 0.042), whereas all cases with type 3 dissection were treated with SAPT. During follow-up, ischemic events and MACE occurred exclusively in patients receiving DAPT (18.8% vs 0%, p=0.032; and 21.9% vs 0%, p=0.016, respectively). No significant associations were found between the antiplatelet regimen and sex, cardiovascular risk factors, left anterior descending artery involvement, number of vessels affected, recurrence of chest pain during hospitalization, lesion progression on repeat angiography, or mortality (all p > 0.05). Conclusion In this cohort of patients with conservatively managed SCAD, DAPT was associated with a higher incidence of ischemic events and MACE during follow-up. Although limited by small sample size and potential confounding by indication, these findings support current evidence suggesting that dual antiplatelet therapy may not confer benefit and could potentially be detrimental in patients with SCAD managed without revascularization.
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Goncalves et al. (2026) conducted a cohort in Spontaneous coronary artery dissection (SCAD) (n=57). Dual antiplatelet therapy (DAPT) vs. Single antiplatelet therapy (SAPT) was evaluated on Major adverse cardiovascular events (MACE) (composite of cardiovascular death, myocardial infarction, stroke or hospitalization for heart failure) (p=0.016). Dual antiplatelet therapy was associated with a higher incidence of major adverse cardiovascular events compared to single antiplatelet therapy in conservatively managed SCAD (21.9% vs 0%, p=0.016).
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