TY - JOUR
T1 - Sex Differences in Spontaneous Coronary Artery Dissection
T2 - A Report of the iSCAD Registry
AU - Tam, Lori M.
AU - Naderi, Sahar
AU - Chi, Gerald
AU - Gornik, Heather L.
AU - Wells, Bryan J.
AU - Kadian-Dodov, Daniella
AU - Grodzinsky, Anna
AU - Taylor, Angela M.
AU - Hess, Connie N.
AU - Lewey, Jennifer
AU - Henkin, Stanislav
AU - Orford, James L.
AU - Lindley, Kathryn J.
AU - Wells, Gretchen L.
AU - Mauricio, Rina
AU - Ouellette, Michelle L.
AU - Trost, Jeffrey
AU - Koczo, Agnes
AU - Saucier, Stephanie
AU - Crousillat, Daniela R.
AU - Tolani, Sonia
AU - Kovacic, Jason C.
AU - Gibson, C. Michael
AU - Leon, Katherine K.
AU - Wood, Malissa J.
AU - Kim, Esther S.H.
N1 - Publisher Copyright:
© 2026 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made
PY - 2026/1
Y1 - 2026/1
N2 - BACKGROUND: Spontaneous coronary artery dissection is a cause of myocardial infarction, which predominantly affects middle-aged women. There are limited data on men with spontaneous coronary artery dissection. METHODS: Information on demographics, presenting characteristics, in-hospital outcomes including major adverse cardiovascular events (composite of myocardial infarction, cerebrovascular accident, or heart failure), length of stay, and discharge medications in men and women were obtained from the multicenter iSCAD (International Spontaneous Coronary Artery Dissection) registry. RESULTS: Of 1252 patients enrolled from 2019 to 2023, 80 (6.4%) were men. Mean age did not significantly differ between sexes (men, 50.2±10.3 versus women 49.7±10.4; P=0.792). Women reported more emotional stress preceding spontaneous coronary artery dissection (10.2% versus 2.5% men; P=0.025). Men reported more physical stress (22.5% versus 7.7% women; P<0.001), both isometric exertion (12.5% versus 2.4% women; P<0.001) and aerobic exertion (12.5% versus 5.6% women, P<0.013). Chest discomfort was the major symptom, although women reported more non-chest discomfort, shortness of breath, and nausea/vomiting. Men had fewer autoimmune conditions, systemic inflammatory disorders, and fibromuscular dysplasia but more recreational drug use. In-hospital major adverse cardiovascular events did not significantly differ (4.1% men versus 8.5% women; P=0.178). The median length of stay was 3.0 (interquartile range, 3.0-4.0) days for males versus 4.0 (interquartile range, 3.0-5.0) days for women (P=0.003). At discharge, more men were prescribed statins (72.5% men versus 55.3% women; P=0.003) and dual antiplatelet therapy (66.3% men versus 53.7% women) (P=0.049). CONCLUSIONS: In a large spontaneous coronary artery dissection registry, there were significant sex differences in presentation, baseline medical conditions, and triggers. In-hospital outcomes were similar, but length of stay was longer for women. Men were more often discharged on statins and dual antiplatelet therapy.
AB - BACKGROUND: Spontaneous coronary artery dissection is a cause of myocardial infarction, which predominantly affects middle-aged women. There are limited data on men with spontaneous coronary artery dissection. METHODS: Information on demographics, presenting characteristics, in-hospital outcomes including major adverse cardiovascular events (composite of myocardial infarction, cerebrovascular accident, or heart failure), length of stay, and discharge medications in men and women were obtained from the multicenter iSCAD (International Spontaneous Coronary Artery Dissection) registry. RESULTS: Of 1252 patients enrolled from 2019 to 2023, 80 (6.4%) were men. Mean age did not significantly differ between sexes (men, 50.2±10.3 versus women 49.7±10.4; P=0.792). Women reported more emotional stress preceding spontaneous coronary artery dissection (10.2% versus 2.5% men; P=0.025). Men reported more physical stress (22.5% versus 7.7% women; P<0.001), both isometric exertion (12.5% versus 2.4% women; P<0.001) and aerobic exertion (12.5% versus 5.6% women, P<0.013). Chest discomfort was the major symptom, although women reported more non-chest discomfort, shortness of breath, and nausea/vomiting. Men had fewer autoimmune conditions, systemic inflammatory disorders, and fibromuscular dysplasia but more recreational drug use. In-hospital major adverse cardiovascular events did not significantly differ (4.1% men versus 8.5% women; P=0.178). The median length of stay was 3.0 (interquartile range, 3.0-4.0) days for males versus 4.0 (interquartile range, 3.0-5.0) days for women (P=0.003). At discharge, more men were prescribed statins (72.5% men versus 55.3% women; P=0.003) and dual antiplatelet therapy (66.3% men versus 53.7% women) (P=0.049). CONCLUSIONS: In a large spontaneous coronary artery dissection registry, there were significant sex differences in presentation, baseline medical conditions, and triggers. In-hospital outcomes were similar, but length of stay was longer for women. Men were more often discharged on statins and dual antiplatelet therapy.
KW - angina pectoris
KW - fibromuscular dysplasia
KW - myocardial infarction
KW - sex differences
KW - spontaneous coronary artery dissection
UR - https://www.scopus.com/pages/publications/105028169465
U2 - 10.1161/JAHA.125.042773
DO - 10.1161/JAHA.125.042773
M3 - Article
C2 - 41532527
AN - SCOPUS:105028169465
SN - 2047-9980
VL - 15
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - e042773
ER -