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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
35. Research Methodology
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SPONTANEOUS CORONARY ARTERY DISSECTION: INTEGRATED PHENOTYPIC, ANGIOGRAPHIC, THERAPEUTIC, AND PSYCHOSOCIAL DETERMINANTS OF OUTCOMES FROM A 10-YEAR TERTIARY-CENTRE REGISTRY
Session:
Sessão de Posters 43 - Da disseção da artéria coronária às decisões antitrombóticas e de reperfusão nas síndromes coronárias agudas
Speaker:
Luana Alves
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Luana Alves; Joana Conde Gonçalves; André Cabrita; Benedita Couto Viana; Erivaldo Andrade; Tiago Prata Branco; Luis Santos; Tânia Proença; Sandra Amorim; Rui André Rodrigues
Abstract
<p><span style="font-family:Times New Roman,Times,serif"><strong>Background:</strong> Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of acute coronary syndromes, mainly affecting young and middle-aged women without traditional cardiovascular risk factors. Its heterogeneous presentation and uncertain management highlight the need for integrated evaluation of anatomical, hormonal, and psychosocial determinants.</span></p> <p><span style="font-family:Times New Roman,Times,serif"><strong>Purpose:</strong> To identify hormonal, angiographic, and psychosocial predictors of acute and long-term outcomes in a 10-year single-centre SCAD registry.</span></p> <p><span style="font-family:Times New Roman,Times,serif"><strong>Methods:</strong> We retrospectively analysed 64 patients with angiographically confirmed SCAD admitted between November 2009 and August 2025 to a tertiary cardiac centre. Dissections were classified by Saw’s criteria. Hormonal status was defined as reproductive-age or post-menopausal, subdivided into premature and typical-age menopause. Major adverse cardiac events (MACE) included cardiovascular death, myocardial infarction, stroke, or hospitalisation for heart failure. As only one patient underwent coronary artery bypass grafting, treatment comparison was limited to percutaneous coronary intervention (PCI) versus conservative therapy. Quality of life (QoL) was categorised as good or poor during follow-up.</span></p> <p><span style="font-family:Times New Roman,Times,serif"><strong>Results:</strong> The cohort comprised 93.8% women; median age was 51 [IQR 44–64] years. Thirty patients were of reproductive age and thirty were post-menopausal (27 typical, 3 premature). Reproductive-age women more often had trigger-related SCAD (63% vs 23%; p=0.002; RR 2.7 [1.3–5.5]) and type 2 dissections, whereas post-menopausal women had higher rates of hypertension and dyslipidaemia (p<0.01). Premature menopause resembled the reproductive-age phenotype, with lower cardiometabolic burden and predominance of type 2 morphology. Type 2/3 dissections (OR 0.097, 95% CI 0.021–0.451; p=0.002) and TIMI ≤2 flow (OR 0.480, 95% CI 0.235–0.983; p=0.044) independently predicted acute complications. Conservative management predominated (90.6%), with favourable in-hospital outcomes across strategies (p=0.86). During follow-up, MACE occurred in 10%, with no angiographic predictors (p=0.554) or treatment differences (p=0.72); Kaplan–Meier analysis confirmed similar event-free survival (p=0.75). Poor QoL occurred in 35.9%, driven by recurrent chest pain (p=0.002) and positive ischaemia testing (p=0.015, AUC 0.88).</span></p> <p><span style="font-family:Times New Roman,Times,serif"><strong>Conclusions:</strong> SCAD predominantly affects women with low atherosclerotic burden and excellent survival under conservative therapy. Hormonal status influences phenotype but not prognosis. Type 2/3 dissections and impaired TIMI flow predict early complications, whereas persistent ischaemic symptoms determine QoL. Long-term outcomes are similar across angiographic subtypes and treatment strategies, supporting conservative management. Multidisciplinary, patient-centred follow-up remains essential for recovery and wellbeing.</span></p>
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