A LANDMARK Australian-New Zealand study of 586 patients with spontaneous coronary artery dissection (SCAD), has identified that oral anticoagulants , dual antiplatelet therapy, fibromuscular dysplasia, and prior stroke history are key predictors of adverse cardiovascular outcomes and recurrence.
SCAD, a tear in the coronary artery wall not caused by trauma, is a leading cause of acute coronary syndrome in young to middle-aged women, though optimal treatment strategies remain debated. This multicentre cohort study aimed to clarify predictors of major adverse cardiovascular events (MACE) and recurrence in SCAD patients, particularly assessing the impact of antithrombotic therapies. With growing evidence suggesting harm from aggressive antiplatelet regimens, the findings could reshape clinical approaches to managing this complex condition.
The study analysed 505 patients (88.6% female, mean age 52.2 years) across 23 centres, with SCAD confirmed via core laboratory imaging. Over a median 21-month follow-up, 8.6% experienced MACE (death, myocardial infarction, stroke, or revascularisation) and 3.6% had SCAD recurrence. Multivariable analysis revealed oral anticoagulation at discharge tripled MACE risk (aHR 3.8, 95% CI 1.6–9.3), while ticagrelor combined with aspirin increased MACE by 80% (aHR 1.8, 95% CI 1.04–3.2). Fibromuscular dysplasia doubled MACE risk (aHR 2.2, 95% CI 1.05–4.5), and prior stroke quadrupled it (aHR 3.8, 95% CI 1.2–12.2). For recurrence, fibromuscular dysplasia (aHR 3.9), dual antiplatelet therapy (aHR 2.6), and stroke history (aHR 6.2) showed stronger associations.
These results underscore the need for cautious antithrombotic prescribing in SCAD management, favouring single over dual antiplatelet therapy. Clinicians should prioritise screening for fibromuscular dysplasia and stroke history when assessing recurrence risk. Future research must validate these findings through randomised trials comparing antithrombotic strategies and explore SCAD’s pathophysiology to develop targeted therapies. For now, the study reinforces a conservative treatment approach, challenging historical reliance on intensive blood-thinning regimens in this vulnerable patient population.
Katrina Thornber, EMJ
Reference
Dang QM et al. The Australian-New Zealand spontaneous coronary artery dissection cohort study: predictors of major adverse cardiovascular events and recurrence. European Heart Journal. 2025;ehaf097.
