Assessment of the Role of NonTraditional Risk Factors on Spontaneous Coronary Artery Dissections

Abstract

Background: Spontaneous coronary dissection (SCAD) and non-traditional risk factors (NT-RF) have assumed increasing interest. Aim: To assess NT-RF in the Parma SCAD registry population. Methods: 62 patients with SCAD, enrolled between January 2013 through November 2021, were divided in two groups: NT-RF (n=51) and T-RF (n = 11). Clinical, echocardiographic and angiographic features were compared between the two study populations; finally, the occurrence of major adverse cardiovascular events was assessed at follow-up. Results: At least one NT-RF among sex related, sex prevalent and gender specific risk factors was present in 82% of patients, while TRF for atherosclerotic disease were less common with hypertension being the most prevalent (40.3%) and diabetes the most seldom (3.2%). Patients with NT-RF were significantly younger (p=0.027) and mostly female compared to those without NT-RF (p=0.004). Type 2 (second Yip/Saw classification) dissection was the prevailing phenotype (54.8%) with a higher prevalence in the NT-RF group (63%, p=0.035). Major Adverse Cardiovascular Events (MACEs) occurred in 17.7% in all patients at a median follow-up of 23 months. When comparing the incidence of cardiovascular events in the 2 study groups, we did not find any significant differences (p=0.4) between groups. Conclusion: SCAD occurs more often in younger women without the traditional RF. Risk estimation does not include these factors and tailored prediction models are lacking. Clinicians and researchers should establish targeted interventions for primary prevention, early diagnosis and secondary prevention in younger women.