Breaking stereotypes: baseline features, treatment strategies, and 12-month outcomes in SCAD AMI patients: findings from the Serbian SCAD registry (SR SCAD)

Abstract Introduction and Purpose Coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS), but it remains poorly understood. We present findings from the only SCAD registry in Eastern transitional countries – the Serbian SCAD Registry (SR SCAD) – from November 2021 to November 2024, which included 123 patients from 14 PCI centers in Serbia. Methods and Results Patients were included retrospectively (27 patients) and prospectively (96 patients), with a mean age of 47.5 ± 11.8 years, and 85.4% were female. The majority of patients presented with ST-segment elevation myocardial infarction (STEMI, 68.3%).The most frequent comorbidities and risk factors were arterial hypertension (49.6%) and dyslipidemia (46.3%) Table 1. Approximately 6.7% of patients were either pregnant or in the postpartum period. Mental stress was the most common precipitating factor (38.5%), and in 10.7% of patients, it was a physical stressor. The most common LAD was the dissected artery (56.1%), followed by RCA (8.9%). Predominantly distal part of the artery was affected (21.9%) and 43.7% had only one artery dissected. The majority of patients had SCAD type 2, 15.8% had type 4, 21.9% had type 1 and 6.1% had SCAD type 3. Only drug therapy was applied in 58.5% of patients. The majority of patients (58.5%) received dual antiplatelet therapy (DAPT) and low-molecular-weight heparin was administered in 56.9% of patients. Statins were used in 22.8% of patients. PCI was performed in 41.5% of patients, and in 28.5% of patients, the affected artery was stented. 50.4% of patients had TIMI 3 flow at the beginning of the coronary angiography and 24.2% of them underwent PCI and 19.4% of them received a stent. Among PCI patients, the most frequently observed was SCAD type 2A (33.3%). 29 patients experienced MACE (major adverse cardiovascular event) during hospitalization: recurrent MI; hemodynamic instability; malignant arrhythmia; congestive heart failure; unplanned revascularization; cerebrovascular event, and 10 patients died. At 30 days, MACE was observed in 18.1% of cases. At the one-year follow-up, MACE was reported in only 5 patients (8.2%). Independent predictors for in-hospital MACE were a history of previous heart diseases, cardiac interventions, and statin therapy. Independent predictors for MACE occurring 30 days after hospitalization were female sex, depression, and stent implantation (Figure 1). Conclusions SCAD AMI was most common in non-pregnant young and middle-aged women, with hypertension and dyslipidemia as the main risk factors. The most frequent presentation of SCAD was STEMI. PCI was performed in 41.5% of patients, and half of these patients had TIMI 3 flow in the affected artery before stent deployment. Stent implantation was the independent predictor of MACE during the first 30 days of follow-up. Increasing awareness that SCAD is not solely a "pregnant woman's disease" must be a priority.Table 1.Baseline characteristicsFor image description, please refer to the figure legend and surrounding text. Figure 1.PrognosisFor image description, please refer to the figure legend and surrounding text.