Psychological and clinical characteristics of patients with spontaneous coronary artery dissection: A case-control study

Veerle R Smaardijk,Paula M.C Mommersteeg,Willem J Kop,Dario Pellegrini,Robert-Jan Van Geuns,Angela H.E.M Maas

doi:10.1016/j.ijcard.2020.08.045

Abstract

BackgroundThe relative frequency of psychological factors in patients with spontaneous coronary artery dissection (SCAD) compared to patients with traditional atherosclerosis-related type 1 acute coronary syndrome (ACS) is unknown. This study examines whether psychological factors and emotional or physical precipitants are more common in SCAD patients versus atherosclerosis-related ACS patients. MethodsParticipants with SCAD were recruited from a Dutch SCAD database. Given the predominance of SCAD in women (>90%), only female patients were included. The age- and sex-matched atherosclerosis-related ACS group was identified from a registry database. Online questionnaires and medical records were used to investigate psychological factors and clinical information. Univariate and multivariate logistic regression models were used to examine differences between 172 SCAD patients and 76 ACS patients on emotional and physical precipitants prior to the event and psychological factors after the event. ResultsPatients with SCAD were more likely to experience an emotional precipitant in the 24 h prior to the event (56%), compared with the ACS group (39%) (OR = 1.98, 95%CI 1.14–3.44). Multivariate analyses showed that this association remained significant after adjustment for covariates (OR = 2.17, 95%CI 1.08–4.36). At an average of 3.2 years post-hospitalization for the SCAD or atherosclerosis-related ACS event, both patient groups had similar high levels of perceived stress (50% vs. 45%, p = .471) and fatigue (56% vs. 53%, p = .643). ConclusionsThis study shows that risk profiles for SCAD differ from traditional atherosclerosis-related ACS. Our findings may help health professionals to recognize SCAD and offer tailored rehabilitation and prevention programs.

Highlights

Spontaneous coronary artery dissection (SCAD) is characterized by a separation within or between any of the three layers of the coronary artery wall, leading to the acute formation of an intramural hematoma and, eventually, a false lumen of the coronary artery, which may cause myocardial ischemia and myocardial infarction [1,2,3]
Psychological factors after spontaneous coronary artery dissection (SCAD) and atherosclerosis-related acute coronary syndrome (ACS) In addition to the aforementioned emotional and physical precipitants that were present before the ACS event, we investigated the presence of psychological factors after the ACS event
Standard cardiovascular risk factors were less frequent in SCAD patients (Table 1)

Summary

Introduction

Spontaneous coronary artery dissection (SCAD) is characterized by a separation within or between any of the three layers of the coronary artery wall, leading to the acute formation of an intramural hematoma and, eventually, a false lumen of the coronary artery, which may cause myocardial ischemia and myocardial infarction [1,2,3]. Migraine is common in patients with SCAD [5] In addition to these unique risk factors for SCAD, evidence suggests that there may be differences between SCAD and atherosclerosis-related ACS with regard to the immediate precipitants of their acute clinical manifestations [6]. The relative frequency of psychological factors in patients with spontaneous coronary artery dissection (SCAD) compared to patients with traditional atherosclerosis-related type 1 acute coronary syndrome (ACS) is unknown. This study examines whether psychological factors and emotional or physical precipitants are more common in SCAD patients versus atherosclerosis-related ACS patients. Univariate and multivariate logistic regression models were used to examine differences between 172 SCAD patients and 76 ACS patients on emotional and physical precipitants prior to the event and psychological factors after the event. Our findings may help health professionals to recognize SCAD and offer tailored rehabilitation and prevention programs

Methods

Results

Discussion

Conclusion