Triggers in patients with spontaneous coronary artery dissection

Background Spontaneous coronary artery dissection (SCAD) is a rare but significant cause of acute coronary syndrome (ACS), particularly in younger women without traditional cardiovascular risk factors. The pathophysiology involves the development of an intramural hematoma or an intimal tear within the coronary artery, leading to luminal narrowing, impaired blood flow, and myocardial ischemia. The exact etiology of SCAD remains unclear, but various triggers have been identified that may contribute to its onset. Purpose The present abstract aims to explore the potential triggers associated with SCAD, including physical and emotional factors. Methods Patients were enrolled both prospectively and retrospectively from a multicentre registry comprising 10 centres across six countries. SCAD was diagnosed and angiographically classified according to the criteria proposed by Saw et al. All coronary angiograms were independently reviewed by two experienced interventional cardiologists. Information regarding potential precipitating events prior to symptom onset was systematically collected. For the purpose of this analysis, triggers were categorized as emotional or physical and further subclassified according to their nature. Results A total of 289 patients were included in this study, with a median age of 51 years (range: 43 to 59 years). Of the 289 patients, 226 (78%) were female. Among these patients, 162 (56%) reported experiencing either an emotional or physical stressful event prior to the SCAD event. Twenty patients (7%) reported both an emotional and physical stressful event. Regarding physical stressors, 29 patients (10%) identified an isometric exercise or Valsalva maneuver performed immediately before the event, 18 patients (6%) reported a hypertensive crisis, and 14 patients (5%) were engaged in endurance exercise. Other contributing factors included neurological disorders, exogenous hormones, and pregnancy-related causes. For emotional stressors, 23 patients (8%) reported stress related to financial or employment problems, 11 patients (4%) cited highly frustrating or anger-inducing events, and 9 patients (3%) experienced acute anxiety or depression. Other emotional triggers included positive events ("happy SCAD"), grief/loss, and interpersonal conflicts. The most frequent combined triggers were work- or financial-related stress together with physical exertion (n=8), while one patient experienced a happy SCAD in combination with a physical trigger. Conclusions SCAD is frequently preceded by identifiable triggers, with emotional and physical stressors playing a substantial role in its onset. Emotional stress, particularly financial or work-related concerns, along with physical exertion and hypertensive episodes, were the most commonly reported precipitants. Understanding these triggers may help identify at-risk individuals and aid in developing prevention strategies.