In 527 SCAD patients, no sex difference in 3-year MACE (8.2% females vs 12.1% males, p=0.2); anticoagulation, DAPT, FMD, stroke predicted higher MACE regardless of sex.
Are there sex differences in clinical presentation, associated conditions, and major adverse cardiovascular events (MACE) in patients with spontaneous coronary artery dissection (SCAD)?
In patients with SCAD, while clinical presentation and associated conditions differ by sex, 3-year MACE rates are similar between males and females.
Absolute Event Rate: 0% vs 0%
Abstract Background Spontaneous coronary artery dissection (SCAD) predominantly affects females with limited data in males. Purpose We aimed to determine sex differences in presentation, associated conditions and major adverse cardiovascular events (MACE) in SCAD. Methods Multicentre cohort study recruited patients with core laboratory confirmed SCAD from 23 Australian/New Zealand sites. Sex differences were analysed using descriptive statistics. A cox proportional hazards model assessed independent predictors of MACE, with an interaction analysis to determine the impact of sex. Results Total 527 patients with SCAD: 468 (88.8%) female, mean age 53.5±10.6 years. Females had higher aspirin use at baseline (10% versus 1.7%, p=0.031) and hypertension (30.6% versus 16.9%, p=0.044), compared to males. Emotional stress as a SCAD precipitant was documented in the medical records in more females (16.0% versus 2.9% males, p=0.042) with no difference when self-reported (60.6% females versus 54.2% males, p=0.715). Females were more likely to have moderate/severe coronary tortuosity (55.0% versus 34.6% males, p=0.009) with no difference in SCAD Type or vessel affected. Fibromuscular dysplasia (FMD) was detected in 24.2% versus 16.7% (p=0.612) and non-FMD vascular abnormalities in 4.0% versus 16.7% (p=0.027) of females versus males screened. There was no sex difference in 3-year MACE; 8.2% females, 12.1% males (log-rank p=0.2). On multivariable analysis, oral anticoagulation, dual antiplatelet therapy (DAPT) comprising aspirin and ticagrelor, FMD and previous stroke were associated with higher MACE, with no significant interaction by sex (all p-values 0.05). Conclusions Females with SCAD had higher rates of hypertension and coronary tortuosity, while males had more non-FMD vascular abnormalities. Self-reported emotional stress was common, equally prevalent in females and males. Anticoagulation, DAPT comprising aspirin and ticagrelor, FMD and previous stroke were independent predictors of MACE with no sex difference.MACE-Free Survival According to Sex
Zaheen et al. (Sat,) reported a other. In 527 SCAD patients, no sex difference in 3-year MACE (8.2% females vs 12.1% males, p=0.2); anticoagulation, DAPT, FMD, stroke predicted higher MACE regardless of sex.