Independent angiographic review identified spontaneous coronary artery dissection in 21.1% of young women with suspected ACS, compared to 12.1% in the registry, indicating initial underdiagnosis.
Observational (n=265)
Yes
What is the prevalence and diagnostic accuracy of SCAD in young women with suspected ACS undergoing invasive coronary angiography?
SCAD is underdiagnosed in young women with suspected ACS, though diagnostic accuracy has improved over time.
Absolute Event Rate: 21.1% vs 12.1%
Abstract Background Previous studies(1-4) suggest that spontaneous coronary artery dissection (SCAD) accounts for up to 35% of acute coronary syndrome (ACS) cases in women under 50 years of age. However, the prevalence of SCAD in Sweden remains unclear, as does the evolution of diagnostic sensitivity and specificity over time. Methods We conducted a retrospective review of all invasive coronary angiographies (ICA) performed between Jan 2015 and Dec 2023 in women 50 years with suspected ACS across two Swedish counties and three hospitals. Patient data were retrieved from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and supplemented by medical record reviews. All ICA images were re-evaluated by two independent interventional cardiologists, blinded to the original assessments. Annual SCAD incidence rates in the pooled patient population were compared with those reported in the registry. Sensitivity, specificity, interobserver agreement, and temporal trends were analysed. Results A total of 265 women 50 years were evaluated. SCAD was documented (as present, absent, or suspected) in 165 cases in SCAAR (62%), with 32 cases identified as SCAD (12.1% of the total cohort; 19.4% of those with SCAD-related registration). Our independent angiographic review identified 56 SCAD cases (21.1% of the total cohort). Interobserver agreement was moderate (κ = 0.62), with a trend toward improvement over time (κ ranging from 0.28 to 0,89; β = 0.706, p = 0.051). Conclusions SCAD was underdiagnosed during the initial years following the introduction of a SCAD-specific variable in the SCAAR registry. Nevertheless, diagnostic accuracy improved over time. Despite this progress, SCAD remains a relatively rare cause of ACS in young women(5), who are still more commonly affected by atherosclerotic disease.Table: Basic characteristics Figure. κ values over time
Pagonis et al. (2026) conducted an observational in Spontaneous coronary artery dissection (SCAD) in suspected ACS (n=265). Independent angiographic review vs. SCAAR registry assessment was evaluated on SCAD identification rate. Independent angiographic review identified spontaneous coronary artery dissection in 21.1% of young women with suspected ACS, compared to 12.1% in the registry, indicating initial underdiagnosis.