Myocardial Infarction In Young Women Research Articles

Young Women and Myocardial Infarction: Unveiling Clinical Patterns and Prognostic Outcomes.

Background Myocardial infarction (MI) remains a critical emergency with an increasing incidence among young women exposed to various risk factors. Despite extensive data on MI, there is limited information on premature coronary artery disease in women under the age of 50 years. This study describes the clinical, paraclinical, and angiographic characteristics of MI in young women compared to older women and determines the prognosis. Methods This is a single-center retrospective study including womenhospitalized between July 2019 and December 2021 in the cardiology departmentfor the evaluation of MI. The population was divided into two groups based on age: women under 50 years, classified as youngwomen, and those aged 50years and above. A comparison was made between these two groups. Results A total of 197 women were included in our study. Forty-four women under 50 and 153 over 50 years were included. The mean age of young women was 44 ± 6 years. The main cardiovascular (CV) risk factors in young women were smoking (46%), hypertension (53%), diabetes (44%), and family history of coronary artery disease (21%). Autoimmune disease was present in 11%. Of the young women,34% were admitted for ST-elevation myocardial infarction (STEMI), with 47% consulting late (>12 hours). The majority (91%) presented with typical chest pain. Monovessel disease was observed in 57% of young women. The left anterior descending artery was the most affected at 55%. Atherosclerosis was the most noted etiology (66%), followed by spontaneous coronary artery dissection (SCAD) (16%). The comparative study showed that young women had fewer overall CV risk factors but a higher prevalence of smoking, familial history of coronary artery disease, and autoimmune disease. Young women presented more frequently with non-ST elevation myocardial infarction (NSTEMI). Monovessel disease was more common, and they required less myocardial revascularization by percutaneous intervention. Young women presented more with SCAD and less with atherosclerotic MI. The in-hospital follow-up showed that young women experienced fewer major cardiac and cerebrovascular events (MACCE) compared to older women, with no in-hospital deaths recorded among young women. Long-term follow-up revealed a lower incidence of MACCE among young women (11% vs. 32.7% in older women) and a similar low mortality rate. Survival analysis showed that young women had a longer event-free survival time for MACCE (91.3 months) compared to older women (65.5 months). Conclusions The incidence of MI in young women is increasing. Smoking and hypertension are major risk factors. Hospital complications are rare, and prognosis is generally good, with low mortality rates.

Spontaneous Coronary Artery Dissection: A Case Series and Review of the Literature.

Although previously considered rare, spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction in young women. We present three unique cases of SCAD: A 46-year-old woman with a history of trigeminal neuralgia and anxiety presenting elevated troponin-I and chest pain. A 36-year-old woman with recent miscarriage presenting with diffuse T wave inversions and elevated troponin-I. A 58-year-old man with a recent COVID-19 infection presenting with diffuse ST elevations. SCAD is associated with many risk factors. Conservative management is preferred due to spontaneous healing of vessels compared to PCI-driven management of atherosclerotic acute coronary syndrome.

Инфаркт миокарда у молодых женщин

The low alertness of physicians and women due to the rare incidence of myocardial infarction in young women, often atypical clinical presentation, and frequent lack of obstructive coronary artery disease accounts for the issue of timely diagnosis. According to Russian researchers, the incidence of acute myocardial infarction in women aged 35–44 years in Russia in 2014 was 0.2%. Foreign studies have shown that slightly over half of young women with ST-elevation myocardial infarction experience typical chest pain. Our case reports highlight the challenges in diagnosing myocardial infarction in young women, and the impact of both gender-related and non-gender-related risk factors Although there is no obstructive coronary atherosclerosis, myocardial infarction in young women can have a severe course and lead to complications such as cardiac aneurysms and chronic heart failure KEYWORDS: myocardial infarction, young women, spontaneous coronary artery dissection FOR CITATION: Khar'kov E.I., Tsibul'skaya N.Yu., Ryabkov E.I., Karaev E.B. Myocardial infarction in young women. Russian Medical Inquiry. 2024;8(1):37–41 (in Russ.). DOI: 10.32364/2587-6821-2024-8-1-6.

153: SPONTANEOUS CORONARY ARTERY DISSECTION FOLLOWING ORTHOTOPIC LIVER TRANSPLANTATION

Introduction: An infrequent presentation of myocardial infarction in young women with symptoms of ACS may be spontaneous coronary artery dissection (SCAD). SCAD has a mean age of presentation at 30-45 years with 70% of patients being women. True SCAD is defined as a non-atherosclerotic disease with risk factors such as connective tissue disease, pregnancy, and vasculitis being identified. However, many cases remain idiopathic in nature and management of the condition continues to be controversial. Description: We present a case of a 39 year old female with a history of factor V leiden, ulcerative colitis, and Budd-Chiari syndrome with cirrhosis who presented for an orthotopic liver transplant (OLT). Pre-operative workup included an echocardiogram demonstrating a LVEF of 60% with no valvular disease. Intra-operatively, the patient required significant resuscitation for an estimated blood loss of 30 liters but was transported to the ICU in stable condition postoperatively. By post-operative day (POD) one she was off all vasopressor infusions and was extubated on POD three. On POD five, the patient had symptomatic ventricular tachycardia with associated chest pain. A 12-lead ECG was obtained showing lateral ST elevations. She was taken for left heart catheterization, which showed ostial dissection of the LAD including 100% occlusion of the mid LAD. Echocardiogram demonstrated anteroseptal and apical wall hypokinesis with retained LVEF. She was emergently evaluated by cardiothoracic surgery and was deemed a poor surgical candidate. She was initiated on anticoagulation and goal directed medical therapy. She was evaluated by rheumatology for connective tissue disease but was found to be negative. She was eventually discharged with follow up. Discussion: SCAD is a rare medical condition, especially following OLT. This case highlights the clinical challenges in critical care management of SCAD with regards to anticoagulation, goal directed medical therapy, and coronary intervention. The incidence and prevalence of the disease is variable and definitive management remains largely unclear.

Stress-induced myocardial infarction in young women: сlinical observation

The article presents a clinical observation of first appeared non-ST elevation myocardial infarction in a 43-year-old young woman with three risk factors: chronic stress, smoking, dyslipidemia. Significant stenosis of the LAD (left anterior descending artery) was diagnosed and surgical intervention was performed: plasty and stenting of the LAD.

Abstract 14695: Prevalence of Extracoronary Vascular Abnormalities Among Patients With Spontaneous Coronary Artery Dissection: A Look at Scad Across the Lifespan

Introduction: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in young women; however, SCAD has also been described in older patients. Differences in SCAD presentation, cardiovascular risk factors, presence of extracoronary vascular abnormalities (EVAs), and management across the lifespan have been understudied. Methods: Single-center cohort study of consecutive patients seen in a dedicated SCAD clinic. Medical history, radiographic, and angiographic data were collected. All patients underwent brain to pelvis CTA imaging to evaluate for EVAs. Patients were stratified into three age groups: 20-40, 40-60, and ≥60 years. Differences among age groups were evaluated using Kruskal-Wallis tests for continuous variables and Pearson Chi-squared tests or Fisher’s exact tests for categorical variables. Results: 193 patients met inclusion criteria, 94.3% women. Prevalence of hypertension (14.8%, 42.6%, and 60%, p<0.001) and dyslipidemia (11.1%, 37.4%, and 53.3%, p<0.001) increased with age. Precipitating factors were significantly different among age groups (p<0.001) with usual exertion more commonly seen in the older cohort (25.5%, 39%, 73.3%). Peripartum SCAD (40%, 2.5%, 0%) and female sex (94.5%, 95.9%, 80%) were more commonly seen in the younger cohort (p<0.001). Younger patients were more frequently discharged on anticoagulation (10.9%, 0.8%, 0%, p<0.004). There were no significant differences in SCAD presentation, vessel involvement, SCAD management, and EVA prevalence. Procedural complications were not different. Conclusions: Older women who develop SCAD have more typical risk factors for ACS including hypertension, and dyslipidemia. Clinical presentation, vessel distribution, and management of SCAD do not vary across age groups. The prevalence of arteriopathies is high and similar across age groups, underscoring the importance of the evaluation for EVAs following SCAD in patients of all ages.

Prognosis of myocardial infarction in young women

Myocardial infarction in young women is rare. it has a poorer prognosis with more complications and an excess mortality in the acute phase compared to MI in young men. Purpose to study the prognostic features of MI in young women. We carried out a prospective study including young women whose age is ≤ 55 years and young men whose age is ≤ 45 years hospitalized for MI in the cardiology department of the CHU Constantine (Algeria) from January 2013 to March 2016. We compared the complications occurring in the acute phase and one year of the event between the 2 groups. Out of 200 MI hospitalized patients, 30.5% were women, with an average age of 48 years. They had more clinical atypia in 34.4% of cases P = NS, more NSTEMI P = NS, had an average of 3 risk factors compared to 2 in men and had more significant coronary lesions. The reperfusion treatment was prescribed with no significant difference in the 2 groups but with a significantly longer mean delay in women. The initial complications were more frequent in women but without significant difference, heart failure 3.3% vs. 1.4%, conductive disorders 11.5% vs. 8.6%, excitability disorders 3.3% vs. 1.4% and embolic complications 4.9% vs. 0%. Hospital complications were significantly frequent in women 32.8% against 20.1%; P = 0.04. With more heart failure 11.5% vs. 6.5%, more excitability disorders 3.3% vs. 1.4%, more conductive disorders 8.2% vs. 2.1%, more thromboembolic complications 3.3% vs. 0% and more LV dysfunction24.6% vs. 18%. Hospital mortality was 4 times more frequent in women 9.8% than men 2.2%; P = 0.02. One year from the initial event, the number of events decreased and tended to be the same for both sexes 7.1% for women versus 8.7% for men. The death rate decreased also 2.4% versus 1.8%. MI in young women has a worse prognosis in the acute phase with excess mortality probably related to more clinical atypia, delayed consultation and severe coronary lesions.

Sex Differences in Young Adults Who Experience Myocardial Infarction

The purpose of this review is to highlight sex differences in presentation, underlying mechanisms, treatment, and outcomes in young adults with myocardial infarction (MI). In addition to traditional plaque rupture and plaque erosion, MI in young women can be caused by spontaneous coronary artery dissection (SCAD), MI with nonobstructive coronary arteries (MINOCA), and type 2 MI. MINOCA is more common in young women compared with young men, has a different epidemiology, and is associated with non-traditional cardiovascular risk factors. Additionally, pregnancy-associated conditions (specifically pre-eclampsia, gestational diabetes, and preterm birth) and premature menopause are increasingly associated with adverse cardiovascular outcomes in young women and should be incorporated into risk assessments. Young women, when compared with young men, are more likely to have delays in the recognition and treatment of acute coronary syndrome, and are less likely to undergo timely coronary angiography and reperfusion. Additionally, rates of the use of guideline-directed medical therapy post-MI are lower for young women when compared with young men. Mechanisms of MI in young women include plaque rupture and erosion, as well as SCAD. Improving prompt recognition of acute coronary syndrome in women and closing the gap between women and men in peri- and post-MI care are key to improve outcomes in young women.

Analysis of Posttraumatic Stress Disorder, Depression, Anxiety, and Resiliency Within the Unique Population of Spontaneous Coronary Artery Dissection Survivors.

BackgroundMental health after spontaneous coronary artery dissection (SCAD), a cause of myocardial infarction in young women, remains largely unexplored. We assessed the prevalence and severity of psychiatric symptoms after SCAD.Methods and ResultsIndividuals with confirmed SCAD who consented to the Mayo Clinic “Virtual” Multicenter SCAD Registry were sent the Posttraumatic Stress Disorder Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Patient Health Questionnaire‐9, Generalized Anxiety Disorder‐7, Anxiety Sensitivity Index, Connor‐Davidson Resilience Scale, 36‐Item Short‐Form Health Survey, and an SCAD‐specific questionnaire. Among 782 patients contacted, 512 surveys were returned. Most respondents were women (97.5%), with median age at time of SCAD and survey completion of 47 and 52 years, respectively. Eighty‐two percent had at least one trauma, with mild or more posttraumatic stress disorder symptoms in 28%. Symptoms of anxiety and depression were observed in 41% and 32%, respectively. On multivariable analysis, those of younger age at first SCAD and low resiliency scored higher on measures of trauma, anxiety, and depression. Those with higher anxiety sensitivity had more severe anxiety and posttraumatic stress disorder symptoms. Emotional and social quality of life was higher in those with high resiliency scores. Time from SCAD event to survey completion was associated with lower Generalized Anxiety Disorder‐7 score severity.ConclusionsSurvivors of SCAD have significant rates of posttraumatic stress disorder, depression, and anxiety, which are associated with lower quality of life specifically among those with lower resiliency. Given the prevalence and potential impact, screening and treatment for the psychological distress is advised. Behavioral interventions targeted toward resiliency training may be beneficial for this patient population.

Low dose combined oral contraceptives induced thrombotic anterior wall myocardial infarction: a case report

BackgroundCombined oral contraceptive pills are associated with an established risk for venous thrombosis; however, their risk for arterial thrombosis remains uncertain, especially with the development of low dose new generations of combined oral contraceptive. Arterial thrombosis is less likely to occur with the use of oral contraceptive pills in the absence of cardiovascular risk factors.Case presentationWe report a 35-year old female with no cardiovascular risk factors who presented with thrombotic anterior wall myocardial infarction 6 months after using a third generation low dose combined oral contraceptive pills (Marvelon; ethinylestradiol 30 mcg and desogestrel 150 mcg).ConclusionThird generation low dose combined oral contraceptives may lead to myocardial infarction in young women, even in the absence of other cardiovascular risk factors.

P978 Acute myocardial infarction in young women without atherosclerotic disease

Abstract INTRODUCTION Spontaneous coronary artery dissection (SCAD) is an established cause of acute myocardial infarction (AMI), with an incidence in young women ranging from 22% to 43%. The increased use of coronary angiography contributed to better recognise this condition. Nonetheless, the presentation remains challenging mainly due to the atypical clinical onset. AIMS AND METHODS A very homogeneous case series of 10 young women (age 36 ± 9 years) admitted at our Institution over a period of 10-years with ST-elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI) were analysed. All women had no congenital, coronary, cardiac and/or atherosclerotic disorders. The clinical and angiographic data were evaluated and correlated to the outcome that lasted 5 ± 5 years. RESULTS The clinical presentation was typical in 70% of cases and 30% of them developed ventricular arrhythmias and cardiogenic shock. An atypical presentation was documented in 30%. STEMI accounted for 70%, NSTEMI for 30%. Among the predisposing factors, pregnancy was related in 20%, connective tissue disorders in 30% and acute emotional stress associated to smoke habit in 50% of cases. On coronary angiogram all women were affected by distinctive pattern of non-atherosclerotic single vessel disease: LAD dissection (50% of cases with proximal localization), first obtuse marginal branch dissection in 3 cases, proximal RCA dissection in 1. Medical therapy was the first choice in 40%, while 60% were treated with PTCA-stent (multiple in 30%). The ejection fraction early after AMI was normal in 70%, mildly reduced in 1 case and moderately reduced (<45%) in 2 cases. Follow-up was negative for events in all cases, 3 underwent pregnancy at distance. CONCLUSION A high proportion of subjects presented with atypical challenging symptoms, while 30% were complicated with ventricular arrhythmias. This might be related to the high prevalence of proximal LAD dissection and anterior AMI in our subjects. An equal distribution of risk factors was recorded. No mortality events and no SCAD-recurrence were documented during follow up. Abstract P978 Figure. Image 1

P5484Cigarette smoking as a risk factor for ST-elevation of myocardial infarction in young women

Abstract Background St-elevation myocardial infarction (STEMI) is the most serious form of clinical presentation of coronary heart disease. Women with STEMI have worse prognosis compared with men. The overall reduction in both incidence of STEMI and active smokers makes it unclear what role smoking continues to play as a risk factor for STEMI in the two sexes. Purpose To use the relation between current cigarette smoking and myocardial infarction to quantify the relative risk (RR) ratio of STEMI in women and men. Methods Data were derived from 11,925 consecutive patients admitted to 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT0128776) from January 2010 to July 2018 with a first acute myocardial infarction. Outcome measures included rates of STEMI at clinical presentation as marker of larger infarctions. Estimates were obtained using logistic-regression and propensity score matching models for current versus never or former smokers. The RR was estimated using men as a reference value. Results Smokers experienced myocardial infarction (either STEMI or non-STEMI) much earlier than did non-smokers both in women (59.0±10.2 versus 68.7±11.30 years) and men (55.8±10.3 versus 63.3±11.7 years). Current tobacco smoking was more prevalent in men (50.35% vs 31.75%) and in younger patients (57.71 vs 28.81%). Among younger patients, smoking remained prevalent in men (60.11% vs 49.85%). Smoking was significantly related to STEMI (OR 1.45; 95% CI: 1.32–1.59) compared with non-STEMI. This association was noted in women (OR 1.61; 95% CI: 1.34–1.93) and men (OR 1.39; 95% CI: 1.24–1.56) and was stronger for younger (<65 years) compared with older ages (ORs 1.49; 95% CI: 1.33–1.67 vs 1.34; 95% CI: 1.13–1.59). The risk of STEMI in young women was higher than in young men (ORs 1.63; 95% CI 1.30–2.06 vs 1.45; 95% CI 1.26–1.66,). Propensity score matching analysis confirmed data. Rates of STEMI in young women and young men were 75.8% versus 64.5%, with a significant RR ratio (OR 1.15; CI 1.07–1.23) across outcomes. Conclusions Although current smoking still is an important risk factor for STEMI at all ages and sexes, it is especially relevant in younger women. Mechanisms underlying the sex difference are not related to differences in smoking behaviour. This finding is a critical reminder that physicians and society should address in rigorous tobacco-control programs in the general population with a distinctive emphasis on women, particularly in those countries where smoking among young women is increasing in prevalence.

Application of the VIRGO taxonomy to differentiate acute myocardial infarction in young women

BackgroundA sex-specific taxonomy was developed from the Variation in Recovery: Role of Gender Outcomes of Young AMI patients (VIRGO) study to better classify young women with AMI who received cardiac catheterization. We aim to determine whether this taxonomy is advantageous to the Universal Definition. MethodsWe conducted a single-center retrospective chart review of consecutive women aged ≤55 years presenting with AMI between 1/1/2013 to 9/1/2016 who underwent cardiac catheterization during the index admission. The proportion of women classified using the Universal Definition of MI and VIRGO classification systems were compared. ResultsAmong women with AMI who underwent cardiac catheterization (n = 177), using the Universal Definition of MI, 68.4% were classified as Type 1, 11.9% as Type 2, and 2.3% as Type 4b; 17.5% were unclassified. Using the VIRGO taxonomy, most (68.4%) were classified as Class I (thrombosis/critical stenosis). The remaining patients were stratified by the presence of obstructive coronary artery disease (CAD) with demand (Class IIa: 4.0%) and without demand (Class IIb: 2.3%) versus non-obstructive CAD with demand (Class IIIa: 6.8%) and without demand (Class IIIb: 10.2%). Alternative discreet mechanisms (Class IV) were seen in 7.3%. Only 1.1% was unclassified. ConclusionsIn a cohort of young women with AMI, 1 in 3 patients who underwent cardiac catheterization did not exhibit the classic mechanism of plaque disruption/thrombosis. By comparison, the VIRGO taxonomy classified more young women and further distinguished presentations within categories of the Universal Definition of MI. Application of this nuanced taxonomy may support the development of individualized diagnostic and treatment strategies in young women with AMI.

PROSPECTIVE REGISTRY OF YOUNG WOMEN WITH MI: EVALUATING THE PREVALENCE AND LONG-TERM IMPACT OF NON-ATHEROSCLEROTIC CORONARY ARTERY DISEASE (PRYME STUDY)

Young women with myocardial infarction (MI) are more likely to have MI with non-obstructive coronary arteries (MINOCA) and non-atherosclerotic coronary artery disease (NACAD). Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of MI in young women. However

Acute myocardial infarction in young women: current perspectives.

Acute myocardial infarction (AMI) is the leading cause of death in women worldwide. Every year, in the USA alone, more than 30,000 young women <55 years of age are hospitalized with AMI. In recent decades, the incidence of AMI is increasing in younger women in the context of increasing metabolic syndrome, diabetes mellitus, and non-traditional risk factors such as stress, anxiety, and depression. Although women are classically considered to present with atypical chest pain, several observational data confirm that men and women experience similar rates of chest pain, with some differences in intensity, duration, radiation, and the choice of descriptors. Women also experience more number of symptoms and more prodromal symptoms compared with men. Suboptimal awareness, sociocultural and financial reasons result in pre-hospital delays in women and lower rates of access to care with resulting undertreatment with guideline-directed therapies. Causes of AMI in young women include plaque-related MI, microvascular dysfunction or vasospasm, and spontaneous coronary artery dissection. Compared with men, women have greater in-hospital, early and late mortality, as a result of baseline comorbidities. Post-AMI women have lower referral to cardiac rehabilitation with more dropouts, lower levels of physical activity, and poorer improvements in health status compared with men, with higher inflammatory levels at 1-year from index presentation. Future strategies should focus on primary and secondary prevention, adherence, and post-AMI health-related quality of life. This review discusses the current evidence in the epidemiology, diagnosis, and treatment of AMI in young women.

Symptoms of Acute Myocardial Infarction in Young Women and Men

It has been reported that women and men suffering acute myocardial infarction (AMI) present with different symptomatology. To ascertain this in adults

Characteristics of extension and de novo recurrent spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is an under-recognised and important cause of myocardial infarction in young women. Recurrent SCAD is frequent but poorly understood. We aimed to explore the clinical and angiographic characteristics, and outcomes of recurrent SCAD. Patients with SCAD extension or recurrence prospectively followed at Vancouver General Hospital were included in this retrospective study. SCAD diagnosis was confirmed by two experienced cardiologists. Detailed medical history, baseline demographics, angiographic results, and clinical details of index SCAD and recurrent events were recorded. SCAD extension was defined as angiographic extension of a previously dissected coronary segment, and de novo recurrent SCAD was defined as new spontaneous dissection. We identified 43 patients with SCAD recurrence with mean age 48.9±8.4 years; 38/43 were women, and 32/43 had fibromuscular dysplasia. Nine patients had SCAD extension at median time of five (1-19) days, while 34 patients had de novo recurrent SCAD at median time of 1,487 (107- 6,461) days after the index SCAD event. All SCAD extension patients had worsening of the index dissected segment, with 5/9 involving extension to adjacent segments, while all de novo recurrent SCAD patients had new dissections affecting coronary segments distinct from the index dissection. De novo recurrent SCAD invariably affected new segments distinct from previously dissected segments.

Pregnancy-related myocardial infarction.

IntroductionThe risk of acute myocardial infarction in young women is low, but increases during pregnancy due to the physiological changes in pregnancy, including hypercoagulability. Ischaemic heart disease during pregnancy is not only associated with increased maternal morbidity and mortality, but also with high neonatal complications. Advancing maternal age and other risk factors for cardiovascular diseases may further increase the risk of ischaemic heart disease in young women.Methods We searched the coronary angiography database of a Dutch teaching hospital to identify women with acute myocardial infarction who presented during pregnancy or postpartum between 2011 and 2013.ResultsWe found two cases. Both women were in their early thirties and both suffered from myocardial infarction in the postpartum period. Acute myocardial infarction was due to coronary stenotic occlusion in one patient and due to coronary artery dissection in the other patient. Coronary artery dissection is a relatively frequent cause of myocardial infarction during pregnancy. Both women were treated by percutaneous coronary intervention and survived.ConclusionPhysicians should be aware of the increased risk of myocardial infarction when encountering pregnant or postpartum women presenting with chest pain.

Myocardial infarction in young women - casuistry or reality? Case report

The problem of myocardial infarction at a young age and in women is very relevant, because there are differences between women and men in the diagnosis of acute coronary syndrome treated by emergency percutaneous coronary intervention by age (women older), higher rate of multi-vessel disease in women, chronic kidney disease, acute heart failure by Killip IV at presentation etc. Learning clinical case of myocardial infarction in young women with coronaropathy possible due to hereditary diseases.

Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes.

Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described. Patients with NA-SCAD prospectively evaluated (retrospectively or prospectively identified) at Vancouver General Hospital were included. Angiographic SCAD diagnosis was confirmed by 2 experienced interventional cardiologists and categorized as type 1 (multiple lumen), 2 (diffuse stenosis), or 3 (mimic atherosclerosis). Fibromuscular dysplasia screening of renal, iliac, and cerebrovascular arteries were performed with angiography or computed tomographic angiography/MR angiography. Baseline, predisposing and precipitating conditions, angiographic, revascularization, in-hospital, and long-term events were recorded. We prospectively evaluated 168 patients with NA-SCAD. Average age was 52.1±9.2 years, 92.3% were women (62.3% postmenopausal). All presented with myocardial infarction. ECG showed ST-segment elevation in 26.1%, and 3.6% had ventricular tachycardia/ventricular fibrillation arrest. Fibromuscular dysplasia was diagnosed in 72.0%. Precipitating emotional or physical stress was reported in 56.5%. Majority had type 2 angiographic SCAD (67.0%), only 29.1% had type 1, and 3.9% had type 3. The majority (134/168) were initially treated conservatively. Overall, 6 of 168 patients had coronary artery bypass surgery and 33 of 168 had percutaneous coronary intervention in-hospital. Of those treated conservatively (n=134), 3 required revascularization for SCAD extension, and all 79 who had repeat angiogram ≥26 days later had spontaneous healing. Two-year major adverse cardiac events were 16.9% (retrospectively identified group) and 10.4% (prospectively identified group). Recurrent SCAD occurred in 13.1%. Majority of patients with NA-SCAD had fibromuscular dysplasia and type 2 angiographic SCAD. Conservative therapy was associated with spontaneous healing. NA-SCAD survivors are at risk for recurrent cardiovascular events, including recurrent SCAD.