New Evidence on Spontaneous Coronary Artery Dissection as Key Cause of Heart Attacks in Younger Women

New insights into spontaneous coronary artery dissection – a devastating cause of heart attacks in young, healthy patients – were presented today at the EAPCI Summit 2026.1 The summit is a new event organised by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), an association of the European Society of Cardiology (ESC).

Spontaneous coronary artery dissection (SCAD) is an emergency condition in which an inner layer of a coronary artery tears away from the outer layer. Blood collects in the space between the layers, causing a haematoma that reduces blood flow and can lead to a heart attack (myocardial infarction [MI]).2 Most patients affected by SCAD are healthy women with few traditional cardiovascular disease risk factors.

“SCAD was considered rare but awareness of the condition is growing. SCAD still remains under-diagnosed and under-studied with few, if any, randomised trials conducted to define the most appropriate treatment approach,” explained study presenter, Professor Svetlana Apostolović from University Clinical Center Nis, Serbia. “The mechanisms responsible for MIs after SCAD are very different from MIs caused by atherosclerosis and yet they are often treated in the same way. We created a national prospective registry to understand more about SCAD, treatment practices and outcomes, and to fill a gap in knowledge about patients from Eastern European countries.”

This analysis of the Serbian SCAD Registry included 123 patients who attended 14 centres specialising in interventional cardiology from November 2021 to November 2024. In total, 27 patients were retrospectively studied and 96 were prospectively studied. Intracoronary imaging techniques were used to establish the SCAD diagnosis in 26.0% of patients.

The majority were female (85.4%) and the mean age was 47.5 years. In total, 6.7% of patients were pregnant or in the postpartum period, while 36.2% were menopausal. The most frequent risk factors were hypertension (49.6%) and dyslipidaemia (46.3%). Where known, the most common precipitating factors were mental stress (38.5%) and physical stress (10.7%).

Percutaneous coronary intervention (PCI) was performed in 41.5% of patients, which involved stent implantation in 28.5% of all patients. Medical therapy alone was received by 58.5%. Overall, more than half of patients received dual antiplatelet therapy (58.5%) and low-molecular weight heparin (56.9%).

During hospitalisation, 23.6% of patients experienced a major adverse cardiovascular event (MACE: recurrent MI, haemodynamic instability, malignant arrhythmia, congestive heart failure, unplanned revascularisation or a cerebrovascular event) and 8.1% of all patients died.

In the 30 days after hospitalisation, 18.1% of patients experienced MACE and 0.8% died. Independent predictors for MACE included stent implantation (p=0.010) and depression (p=0.008).

Full resolution of SCAD was observed in 62.2% of patients after 30 days.

Professor Apostolović summed up the findings: “SCAD was most common in non-pregnant young women and menopausal women, with intracoronary imaging found to be particularly useful in enabling accurate diagnosis. SCAD often resolved fully and stent implantation was not beneficial in the majority of patients. Careful observation alongside beta-blockers, blood-pressure lowering medication, cardiac rehabilitation and psychological support may improve outcomes and reduce the impact on patients’ daily lives, but more studies and trials are needed.”