Key result
SCAD in young women is linked to similar 30-day but ~52% lower 3-year mortality versus AMI.
Why the study?
SCAD is an increasingly recognized cause of AMI in young women, but long-term comparisons with atherosclerotic AMI are limited.
Does spontaneous coronary artery dissection (SCAD) result in different intermediate and long-term outcomes compared to atherosclerotic myocardial infarction in women aged 18-55 years?
Cohort (n=2,594)
Yes
Does spontaneous coronary artery dissection (SCAD) result in different intermediate and long-term outcomes compared to atherosclerotic myocardial infarction in women aged 18-55 years?
Hazard Ratio: 0.72
Absolute Event Rate: 1.2% vs 1.7%
p-value: p=0.33
In young women, SCAD is associated with similar 30-day mortality but significantly better long-term outcomes, including lower mortality and heart failure, compared to atherosclerotic AMI.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“SCAD was most common in non-pregnant young women and menopausal women, with intracoronary imaging found to be particularly useful in enabling accurate diagnosis. SCAD often resolved fully and stent implantation was not beneficial in the majority of patients. Careful observation alongside beta-blockers, blood-pressure lowering medication, cardiac rehabilitation and psychological support may improve outcomes and reduce the impact on patients' daily lives, but more studies and trials are needed.”
SCAD versus atherosclerotic AMI outcomes in young women need prospective validation; leaves open questions on differential long-term management.
Background Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute myocardial infarction (AMI) in young women, yet long-term comparisons with atherosclerotic AMI are limited. We compared outcomes in women aged 18–55 years with these two conditions.Methods Using the TriNetX research network, we conducted a retrospective cohort study of women aged 18–55 years with SCAD or atherosclerotic myocardial infaction(AMI). Cohorts were balanced by 1:1 propensity score matching, and outcomes assessed at 30 days, 1 year, and 3 years. Sensitivity analyses used age-only, Body Mass Index (BMI) only, and SCAD-without-acute-MI cohorts.Results After matching, 1,297 patients were included per cohort. Thirty-day mortality was similar (1.2% vs 1.7%; HR 0.72, p = 0.33), but heart failure was less frequent in SCAD (HR 0.44, p = 0.001). SCAD remained associated with lower 1-year heart failure (HR 0.38, p < 0.001) and, at 3 years, lower mortality (HR 0.48, p = 0.002), stroke (HR 0.45, p = 0.012), heart failure (HR 0.33, p < 0.001), ventricular tachycardia (HR 0.48, p = 0.008), angina (HR 0.26, p < 0.001), and rehospitalization (HR 0.34, p < 0.001). Benefits persisted across all sensitivity analyses.Conclusions Compared with atherosclerotic AMI, women with SCAD had more favorable intermediate- and long-term outcomes despite similar early mortality. These hypothesis-generating findings may warrant tailored management strategies that merit prospective evaluation.
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Awad et al. (2026) conducted a cohort in Spontaneous coronary artery dissection (SCAD) or atherosclerotic myocardial infarction (AMI) (n=2,594). Spontaneous coronary artery dissection (SCAD) vs. Atherosclerotic myocardial infarction (AMI) was evaluated on 30-day mortality (HR 0.72, p=0.33). Spontaneous coronary artery dissection in young women was associated with similar 30-day mortality (1.2% vs 1.7%; HR 0.72, p=0.33) but lower 3-year mortality (HR 0.48) compared to atherosclerotic AMI.
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