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Background <p>Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome, particularly in younger individuals. In-hospital complications can result in adverse outcomes, including repeated procedures and prolonged hospital stays. There is a need to identify patients who are at a higher risk of adverse events or a more complex hospital course.</p> Methods <p>Using data from the iSCAD Registry, a multicenter registry of patients with SCAD, we built univariate and multivariable logistic regression models to assess the association between baseline factors related to the index admission and a complicated hospital course. A complicated hospital course was defined as the occurrence of recurrent myocardial infarction (MI), cerebrovascular accident (CVA), a new arrhythmia, heart failure requiring diuretics, ≥ 2 angiograms performed, need for mechanical support or a hospital admission of more than 5 days. The multivariable logistic regression model was developed using a backward selection approach with exit criteria set at <i>p</i> &gt; 0.2.</p> Results <p>Of the 984 patients included, 219 patients (22.3%) had a complicated hospital course. In our final multivariable model, the following was associated with an increased risk of complicated hospitalization: Obesity, history of cardiomyopathy, arrest or shock at presentation, left anterior descending artery dissection, reduced ejection fraction, presence of structural complications, coronary artery bypass grafting, and current or prior history of P-SCAD.</p> Conclusion <p>In our cohort of patients with SCAD, we identified baseline characteristics that were associated with a risk of complex hospitalization. Recognizing these risk factors can help tailor acute care and guide decisions on closer observation.</p>

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Factors associated with a complicated hospital course in patients with spontaneous coronary artery dissection: a report of the iSCAD registry

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月18日

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  • Fahad Alkhalfan,
  • Malissa Wood,
  • Katherine Leon,
  • C. Michael Gibson,
  • Gerald Chi,
  • Anna Grodzinsky,
  • Heather L Gornik,
  • Bryan J Wells,
  • Jennifer Lewey,
  • Angela Taylor,
  • Daniella Kadian-Dodov,
  • Connie N Hess,
  • Stanislav Henkin,
  • Kathryn J. Lindley,
  • Gretchen Wells,
  • James L Orford,
  • Lori Tam,
  • Dharam J Kumbhani,
  • Samuel Norris,
  • Cassandra Reyes,
  • Clara Vitarello,
  • Sahar Naderi,
  • Esther SH Kim

摘要

Background

Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome, particularly in younger individuals. In-hospital complications can result in adverse outcomes, including repeated procedures and prolonged hospital stays. There is a need to identify patients who are at a higher risk of adverse events or a more complex hospital course.

Methods

Using data from the iSCAD Registry, a multicenter registry of patients with SCAD, we built univariate and multivariable logistic regression models to assess the association between baseline factors related to the index admission and a complicated hospital course. A complicated hospital course was defined as the occurrence of recurrent myocardial infarction (MI), cerebrovascular accident (CVA), a new arrhythmia, heart failure requiring diuretics, ≥ 2 angiograms performed, need for mechanical support or a hospital admission of more than 5 days. The multivariable logistic regression model was developed using a backward selection approach with exit criteria set at p > 0.2.

Results

Of the 984 patients included, 219 patients (22.3%) had a complicated hospital course. In our final multivariable model, the following was associated with an increased risk of complicated hospitalization: Obesity, history of cardiomyopathy, arrest or shock at presentation, left anterior descending artery dissection, reduced ejection fraction, presence of structural complications, coronary artery bypass grafting, and current or prior history of P-SCAD.

Conclusion

In our cohort of patients with SCAD, we identified baseline characteristics that were associated with a risk of complex hospitalization. Recognizing these risk factors can help tailor acute care and guide decisions on closer observation.