Outcomes and Treatment Disparities in Non-obstetric Spontaneous Coronary Artery Dissection in the United States: A 2022 National Inpatient Sample Analysis

Key findings from this study

This research indicates that:

• women with non-obstetric SCAD received percutaneous coronary intervention less frequently than men despite similar clinical severity
• Black patients with SCAD experienced higher adjusted mortality odds compared to White patients
• cardiogenic shock was the strongest independent predictor of mortality, increasing death odds approximately sixfold

Overview

This study analyzed hospitalizations for non-pregnancy-associated spontaneous coronary artery dissection (SCAD) using the 2022 National Inpatient Sample to characterize mortality outcomes and treatment patterns. SCAD represents an important non-atherosclerotic cause of acute coronary syndrome affecting predominantly women. The analysis applied strict exclusion criteria to ensure a homogeneous cohort excluding pregnancy-related, peripartum, and obstetric complications.

Methods and approach

Researchers conducted a retrospective cohort analysis of adult hospitalizations with primary SCAD diagnosis using ICD-10-CM codes. The cohort excluded pregnancy-related admissions, peripartum cardiomyopathy, obstetric complications, and patients under 18 years. Statistical analyses incorporated survey weights to generate nationally representative estimates. Multivariable logistic regression identified predictors of in-hospital mortality and treatment utilization.

Results

The cohort comprised 4,563 hospitalizations with mean age 52.4 years and 72.6% female representation. Overall in-hospital mortality was 3.2%. Women underwent percutaneous coronary intervention (PCI) at significantly lower rates than men (28.4% versus 36.9%) despite equivalent cardiogenic shock incidence (9.1% versus 8.0%). Black patients demonstrated higher adjusted mortality odds than White patients (adjusted odds ratio 1.42, 95% CI: 1.08-1.86).

Cardiogenic shock emerged as the strongest mortality predictor, increasing odds of death nearly sixfold. Chronic kidney disease and advancing age independently predicted mortality. PCI was not independently associated with reduced in-hospital mortality. Sex-based disparities in treatment utilization persisted despite clinically similar presentations.

Implications

Sex- and race-based disparities in SCAD management indicate systemic inequities in cardiovascular care delivery. The lack of mortality benefit from PCI in this cohort suggests contemporary treatment protocols may require reassessment or that treatment selection reflects unmeasured confounding. Standardized management strategies addressing diagnostic and therapeutic pathways could improve equity and potentially reduce mortality disparities across demographic groups.

Scope and limitations

This summary is based on the study abstract and available metadata. It does not include a full analysis of the complete paper, supplementary materials, or underlying datasets unless explicitly stated. Findings should be interpreted in the context of the original publication.