TY - JOUR
T1 - Quality of care for spontaneous coronary artery dissection from the Australian–New Zealand SCAD Registry
AU - Dang, Quan M.
AU - Zaheen, Mithila
AU - Pender, Patrick
AU - Chandrasekhar, Jaya
AU - Psaltis, Peter J.
AU - Marathe, Jessica A.
AU - Burgess, Sonya
AU - Mukherjee, Swati
AU - Makarious, David
AU - Kritharides, Leonard
AU - Jepson, Nigel
AU - Fairley, Sarah
AU - Ihdayhid, Abdul
AU - Layland, Jamie
AU - Szirt, Richard
AU - El-Jack, Seif
AU - Puri, Aniket
AU - Davis, Esther
AU - Shiekh, Imran
AU - Arnold, Ruth
AU - Watts, Monique
AU - Lo, Hui Zhen
AU - Bhagwandeen, Rohan
AU - Wing-Lun, Edwina
AU - Bhindi, Ravinay
AU - Ford, Tom
AU - Lo, Sidney
AU - Marschner, Simone
AU - Zaman, Sarah
N1 - Publisher Copyright:
© 2026 The Authors
PY - 2026/8/20
Y1 - 2026/8/20
N2 - Background: Spontaneous coronary artery dissection (SCAD) is an important but under-recognised cause of acute coronary syndrome (ACS). In 2018, the American Heart Association and the European Society of Cardiology published the first consensus documents that recommended the following for patients with SCAD: at least single antiplatelet therapy, beta-blocker therapy, fibromuscular dysplasia (FMD) screening, and cardiac rehabilitation. Aim: We aimed to assess adherence to key quality-of-care recommendations for SCAD survivors and changes in practice over time. Method: A 23-hospital multicentre cohort study in Australia and New Zealand from 2010 to 2024 included patients aged 18 years and older with an ACS and SCAD confirmed on core laboratory adjudication of invasive coronary angiography. Logistic regression analysis with adjustment for age, sex, type of ACS, percutaneous coronary intervention, left ventricular function, and hypertension was used to assess changes in care over time. Results: A total of 567 patients with core laboratory–confirmed SCAD were included, mean age 52.0±10.5, 89.1% female, 66.7% non-ST elevation ACS, 33.3% ST elevation ACS, and 10.9% received percutaneous coronary intervention. Overall, 95.4% of patients received at least one antiplatelet agent, 80.8% were on beta-blocker therapy, 47.8% were screened for FMD, 76.0% were referred to cardiac rehabilitation, and 33.3% received all four recommendations. On multivariable logistic regression modelling, the proportion of SCAD survivors who received at least one antiplatelet reduced over time (adjusted odds ratio [aOR] 0.69; 95% confidence interval [CI] 0.51–0.89), beta-blocker therapy was unchanged (aOR 1.08; 95% CI 0.99–1.18), and FMD screening (aOR 1.24; 95% CI 1.13–1.30) and cardiac rehabilitation referral (aOR 1.16; 95% CI 1.07–1.25) significantly increased. Conclusions: A low proportion of Australian and New Zealand patients with SCAD received all recommended care, with particularly low rates of FMD screening. Significant improvements in FMD screening and cardiac rehabilitation referral were seen over time, but this did not apply to antiplatelet therapy.
AB - Background: Spontaneous coronary artery dissection (SCAD) is an important but under-recognised cause of acute coronary syndrome (ACS). In 2018, the American Heart Association and the European Society of Cardiology published the first consensus documents that recommended the following for patients with SCAD: at least single antiplatelet therapy, beta-blocker therapy, fibromuscular dysplasia (FMD) screening, and cardiac rehabilitation. Aim: We aimed to assess adherence to key quality-of-care recommendations for SCAD survivors and changes in practice over time. Method: A 23-hospital multicentre cohort study in Australia and New Zealand from 2010 to 2024 included patients aged 18 years and older with an ACS and SCAD confirmed on core laboratory adjudication of invasive coronary angiography. Logistic regression analysis with adjustment for age, sex, type of ACS, percutaneous coronary intervention, left ventricular function, and hypertension was used to assess changes in care over time. Results: A total of 567 patients with core laboratory–confirmed SCAD were included, mean age 52.0±10.5, 89.1% female, 66.7% non-ST elevation ACS, 33.3% ST elevation ACS, and 10.9% received percutaneous coronary intervention. Overall, 95.4% of patients received at least one antiplatelet agent, 80.8% were on beta-blocker therapy, 47.8% were screened for FMD, 76.0% were referred to cardiac rehabilitation, and 33.3% received all four recommendations. On multivariable logistic regression modelling, the proportion of SCAD survivors who received at least one antiplatelet reduced over time (adjusted odds ratio [aOR] 0.69; 95% confidence interval [CI] 0.51–0.89), beta-blocker therapy was unchanged (aOR 1.08; 95% CI 0.99–1.18), and FMD screening (aOR 1.24; 95% CI 1.13–1.30) and cardiac rehabilitation referral (aOR 1.16; 95% CI 1.07–1.25) significantly increased. Conclusions: A low proportion of Australian and New Zealand patients with SCAD received all recommended care, with particularly low rates of FMD screening. Significant improvements in FMD screening and cardiac rehabilitation referral were seen over time, but this did not apply to antiplatelet therapy.
KW - Antiplatelet
KW - Beta blocker
KW - Cardiac rehabilitation
KW - Fibromuscular dysplasia
KW - Quality of care
KW - Spontaneous coronary artery dissection
UR - https://www.scopus.com/pages/publications/105048186194
U2 - 10.1016/j.hlc.2026.03.071
DO - 10.1016/j.hlc.2026.03.071
M3 - Article
C2 - 42624763
AN - SCOPUS:105048186194
SN - 1443-9506
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
ER -