Outcomes and Treatment Disparities in Non-obstetric Spontaneous Coronary Artery Dissection in the United States: A 2022 National Inpatient Sample Analysis

Spontaneous coronary artery dissection (SCAD) has emerged as a critically important non-atherosclerotic cause of acute coronary syndrome that disproportionately affects women, yet contemporary data on non-pregnancy-associated SCAD remain limited, particularly regarding treatment patterns and disparities in care delivery. We conducted a retrospective cohort study using the 2022 National Inpatient Sample, identifying adult hospitalizations with a primary diagnosis of SCAD using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. To ensure a homogeneous non-obstetric cohort, we applied strict exclusion criteria, removing pregnancy-related admissions, peripartum cardiomyopathy, obstetric complications, and patients under 18 years of age. All statistical analyses were performed using STATA version 18.0 (StataCorp LLC, College Station, TX), incorporating survey weights to generate nationally representative estimates. Multivariable logistic regression analysis was performed to identify predictors of in-hospital mortality and treatment utilization. A total of 4,563 hospitalizations met the inclusion criteria, with a mean age of 52.4 ± 11.8 years and 72.6% (n = 3,313) female patients. The overall in-hospital mortality rate was 3.2% (n = 146). Women were significantly less likely to undergo percutaneous coronary intervention compared to men, with rates of 28.4% (n = 941) versus 36.9% (n = 483), respectively, despite having similar rates of cardiogenic shock (9.1% (n = 301) vs. 8.0% (n = 96)). Racial disparities were evident, as Black patients demonstrated higher adjusted odds of mortality compared to White patients, with an adjusted odds ratio of 1.42 (95% CI: 1.08-1.86). Independent predictors of mortality included cardiogenic shock, which increased the odds of death nearly sixfold, chronic kidney disease, and increasing age. Notably, percutaneous coronary intervention was not independently associated with reduced in-hospital mortality. In this nationally representative cohort, non-pregnancy-associated SCAD was associated with low but clinically significant mortality. Marked sex- and race-based disparities in treatment and outcomes persist, underscoring the urgent need for standardized management strategies and equitable cardiovascular care delivery.