What is the clinical evidence from this study?

Study design: Cohort. Population: Spontaneous coronary artery dissection (SCAD) (n=750). Primary outcome: 3-year major adverse cardiovascular events (MACE).

What question did this study set out to answer?

To define the long-term natural history and outcomes of spontaneous coronary artery dissection (SCAD).

May 17, 2026

Canadian Spontaneous Coronary Artery Dissection Cohort Study

Key Result

Spontaneous coronary artery dissection was associated with a 3-year overall MACE rate of 14.0%, including a 0.8% mortality rate and 9.9% recurrent MI rate.

Key Points

To define the long-term natural history and outcomes of spontaneous coronary artery dissection (SCAD).
Multicenter, prospective, observational study conducted at 22 North American centers.
Enrolled 750 patients with nonatherosclerotic SCAD from June 2014 to June 2018.
Cox regression multivariable analysis performed to identify predictors of outcomes.
At 3 years, mortality was 0.8% and major adverse cardiovascular events (MACE) were 14.0%.
Recurrent myocardial infarction rate was 9.9%, with predictors including genetic disorders and fibromuscular dysplasia.
Patients treated with percutaneous coronary intervention had similar postdischarge MACE rates compared to those without PCI.

Study Design

Type

Cohort (n=750)

Multicenter

Yes

Structured PICO

Population

750 consecutive patients with nonatherosclerotic spontaneous coronary artery dissection (SCAD) presenting acutely, mean age 51.7, 88.5% women, from 22 North American centers.

Intervention

Observational management (84.3% treated conservatively, 14.1% underwent PCI, 0.7% CABG)

Outcome

In-hospital and 3-year major adverse cardiovascular events (MACE)composite

In a large contemporary cohort of patients with SCAD, long-term mortality and de novo recurrence were low, with most patients successfully managed conservatively.

Abstract

BACKGROUND Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in young to middle-aged women. OBJECTIVES We aim to define the long-term natural history of SCAD. METHODS We performed a multicenter, prospective, observational study of patients with nonatherosclerotic SCAD presenting acutely from 22 North American centers. We recorded baseline demographics, in-hospital characteristics, precipitating and predisposing conditions, angiographic features (adjudicated), in-hospital and 3-year major adverse cardiovascular events (MACE). Cox regression multivariable analysis was performed. RESULTS We prospectively enrolled 750 consecutive patients with SCAD from June 2014 to June 2018. Mean age was 51.7 ± 10.5 years, 88.5% were women (55.0% postmenopausal); 31.3% presented with ST-segment elevation myocardial infarction, and 68.3% with non-ST-segment elevation myocardial infarction. Precipitating emotional stressor was reported in 50.3%, and physical stressor in 28.9%. Predisposing conditions included fibromuscular dysplasia in 42.9% (56.4% in those with complete screening), peripartum state 4.5%, and genetic disorders 1.6%. Most patients were treated conservatively (84.3%); 14.1% underwent percutaneous coronary intervention (PCI), 0.7% coronary artery bypass graft. At 3.0-year median follow-up, mortality was 0.8%, recurrent MI 9.9% (extension of previous SCAD 3.5%, de novo recurrent SCAD 2.4%, iatrogenic dissection 1.9%), with overall MACE 14.0%. Presence of genetic disorders, peripartum SCAD, and extracoronary fibromuscular dysplasia were independent predictors of 3-year MACE. Patients who underwent PCI at index hospitalization had similar postdischarge MACE compared with no PCI. At 3 years, 80.0% remained on aspirin and 73.5% on beta-blockade. CONCLUSIONS Long-term mortality and de novo recurrent SCAD was low in our contemporary large SCAD cohort that included low revascularization rate and high use of beta-blockade and aspirin. Genetic disorders, extracoronary fibromuscular dysplasia, and peripartum SCAD were independent predictors of long-term MACE.

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