Spontaneous Coronary Artery Dissection: Sex Differences in Clinical Presentation and Outcomes From the Australian New Zealand Registry.

Abstract

BACKGROUND: Spontaneous coronary artery dissection (SCAD) predominantly affects women with limited data in men. We aimed to determine sex differences in SCAD presentation, associated conditions, and major adverse cardiovascular events (MACE). METHOD(S): Cohort study of 23 ANZ-SCAD sites (Australian/New Zealand Registry, data previously published) with core laboratory confirmed SCAD. Descriptive statistics for sex differences. Interaction analysis with Cox proportional hazards model assessed the effect of sex on previously published independent predictors of MACE. RESULT(S): Of a total of 527 patients with SCAD, 468 (88.8%) were female. Mean age was similar, at 53.5+/-10.6 in women and 52.2+/-10.7 in men. Women had higher rates of hypertension (30.6% versus 16.9% men, P=0.044). Emotional stress as a SCAD precipitant was documented in the medical records in more women (16.0% versus 2.9% men, P=0.042) with no difference when self- reported (60.6% women versus 54.2% men, P=0.715). Women were more likely to have moderate/severe coronary tortuosity (55.0% versus 34.6% men, P=0.009). 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 women versus men screened. There was no sex difference in 3- year MACE; 8.2% women, 11.9% men (log- rank P=0.2). There was no interaction by sex (all P values >0.05) with variables associated with increased MACE, namely oral anticoagulation, dual antiplatelet therapy comprising aspirin and ticagrelor, FMD, and previous stroke. CONCLUSION(S): Women with SCAD had higher rates of hypertension, coronary tortuosity, and FMD, whereas men had more non- FMD vascular abnormalities. Self- reported emotional stress was common, equally prevalent in women and men. Anticoagulation, dual antiplatelet therapy, FMD, and previous stroke were independent predictors of MACE in both women and men.Copyright © 2026 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.