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

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.