Key result
Physical stress precedes SCAD in ~86% of men, while emotional stress more commonly affects women.
Why the study?
SCAD is an underdiagnosed cause of acute coronary syndrome with limited information, warranting evaluation of the features of patients experiencing prior psychophysical stress.
Systematic Review (n=105)
In patients with SCAD preceded by psychophysical stress, physical stress is the predominant trigger in men, while emotional stress is significantly more common in women.
Sex-specific SCAD stress triggers merit clinical awareness; extends observational data but leaves open prospective validation.
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, particularly in younger women. Due to limited information about SCAD, case reports and case series can provide valuable insights into its features and management. This study aimed to comprehensively evaluate the features of SCAD patients who experienced psychophysical stress before the SCAD event. METHODS: We conducted an electronic search of PubMed, Scopus, and Web of Science from inception until January 7, 2023. We included case reports or series that described patients with SCAD who had experienced psychophysical stress before SCAD. Patients with pregnancy-associated SCAD were excluded from our analysis. RESULTS: In total, we included 93 case reports or series describing 105 patients with SCAD. The average patient age was 44.29 ± 13.05 years and a total of 44 (41.9%) of patients were male. Among the included SCAD patients the most prevalent comorbidities were fibromuscular dysplasia (FMD) and hypertension with the prevalence of 36.4 and 21.9%, respectively. Preceding physical stress was more frequently reported in men than in women; 38 out of 44 (86.4%) men reported physical stress, while 36 out of 61 (59.1%) females reported physical stress (p value = 0.009). On the other hand, the opposite was true for emotional stress (men: 6 (13.6%)), women: 29 (47.6%), p value < 0.001). Coronary angiography was the main diagnostic tool. The most frequently involved artery was the left anterior descending (LAD) (62.9%). In our study, recurrence of SCAD due to either the progression of a previous lesion or new SCAD in another coronary location occurred more frequently in those treated conservatively, however the observed difference was not statistically significant (p value = 0.138). CONCLUSION: While physical stress seems to precede SCAD in most cases, emotional stress is implicated in females more than males.
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Hosseini et al. (2024) conducted a systematic review in Spontaneous coronary artery dissection (SCAD) (n=105). Psychophysical stress was evaluated on Physical stress preceding SCAD (men vs women) (p=0.009). Physical stress preceded spontaneous coronary artery dissection in 86.4% of men compared to 59.1% of women, whereas emotional stress was more common in women (47.6%) than men (13.6%).
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