Spontaneous coronary artery dissection (SCAD) in men: an observational study

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Abstract Background/Introduction SCAD is a rare cause of acute coronary syndrome. Approximately 90% of SCAD patients are women, and factors such as the hormonal changes of the menstrual cycle are thought to be relevant. It is therefore interesting to consider why patients without such hormonal exposure may be affected. SCAD in men remains poorly understood. Purpose To study the clinical features and natural history of SCAD in men and to see how it differs from SCAD in women. Methods Patients with SCAD were recruited by self-referral and clinician referral from across the UK. Angiograms are reviewed by two experienced cardiologists and other data is obtained from patient questionnaires and from medical records. Results 53 male SCAD patients were identified from the registry. Mean age at SCAD was 47±5.4 (SD). 1 presented with cardiac arrest, 2 as chronic dissections without a clear acute event, 15 as STEMI and 32 as NSTEMI; admission ECGs were not available for 3 patients. The vessel affected was the circumflex in 15 patients, RCA in 4, LAD in 27 and multi vessel in 7. SCAD type was 1 in seven patients, 2a in 21, 2b in 16, 3 in 7 and 4 in 2. LV function post SCAD was normal in 37 out of 50 patients with data available and mean EF was 52.4%. Of 37 with cardiac MRI data, 11 had no visible late gadolinium enhancement. 23 patients had been screened for fibromuscular dysplasia and only 1/23 had this diagnosis. 2 other patients had a non-FMD aortopathy (dilated ascending aorta) and 1 had a very small cerebral aneurysm that was not thought to represent FMD. Mean follow up from the first SCAD event was 3 years (SD 2 years); over this time period 10/51 patients had recurrent SCAD (2 patients presented as chronic dissections on elective angiography and it was not possible to date the index event). Conclusions This is the largest study so far reported of SCAD in men. The mean age was similar to that seen in women, though with a narrower age range, and the proportions of STEMI and NSTEMI are also similar. The most frequently affected vessel was the LAD. Type 2 SCAD was by far the commonest angiographic appearance. The majority of patients had preserved LV systolic function and a significant proportion had no measurable scar. These findings suggest that the presenting features of SCAD in men are very similar to those in women. The incidence of FMD appears to be far lower than in women, however; studies in female SCAD patients suggest that FMD is present in 11–86% (depending on methods used for screening). Finally, rate of recurrent SCAD in men appears significant. The largest series so far reported in SCAD (327 patients, 90.5% women, followed prospectively) showed a recurrence rate of 10.4% over 3 years. We saw a recurrence rate of 19.6%. This may simply represent the play of chance in a small population, or recruitment bias as our study is primarily retrospective, however it is an intriguing observation worthy of further investigation. Funding Acknowledgement Type of funding source: Other. Main funding source(s): BeatSCAD