Spontaneous Coronary Artery Dissection in Highly Active Individuals: Insights From a Prospective Registry

Background: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of acute coronary syndrome that disproportionately affects young, healthy women. While physical exertion has been implicated as a potential trigger, the clinical characteristics of highly active individuals (HAIs) with SCAD remain poorly understood. Objectives: The purpose of this study was to compare patient characteristics, SCAD presentation and management, and SCAD recurrence rates between HAIs and non-HAIs using data from a large, prospective SCAD registry. Methods: We analyzed 833 participants with angiographically confirmed SCAD from the Mayo Clinic SCAD “Virtual” Multi-Center Registry who completed vital components of a supplemental survey. HAIs were defined as individuals participating in competitive or structured physical activity ≥30 min/d, ≥5 d/wk for ≥12 months. Characteristics and outcomes were compared between HAIs (n = 245) and non-HAIs (n = 588). Results: HAIs had a lower prevalence of hypertension, smoking, and lower body mass index. HAIs were more likely to present with non–ST-segment elevation myocardial infarction and cardiac arrest with initial SCAD event, and less likely with ST-segment elevation myocardial infarction, multivessel or left main SCAD, or pregnancy-associated SCAD. Exercise-related SCAD was much more common in HAIs, present in 44.5% vs 28.2% of non-HAIs (P < 0.001). Among HAIs, 2.9% experienced an out-of-hospital cardiac arrest in association with exercise, compared to 0.7% of non-HAIs (P = 0.012). Recurrent SCAD and major adverse cardiac events did not differ between groups. Conclusions: HAIs with SCAD demonstrate a distinct clinical profile which may represent a unique phenotype. HAIs with SCAD were not at higher risk of recurrence or major adverse cardiac event at 10-year follow-up.