Spontaneous Coronary Artery Dissection and Menopause.

Spontaneous coronary artery dissection (SCAD) is a relatively rare but well-known cause of acute coronary syndrome (ACS) in women. The role of sexual hormones has been related to the pathophysiology of SCAD. However, clinical features, angiographic findings, management and outcomes of SCAD women in relation to menopause status remain unknown. The Spanish multicenter prospective SCAD registry (NCT03607981), included 318 consecutive patients with SCAD. All coronary angiograms were analyzed in a centralized Corelab. In this substudy, 245 women were classified according to their menopause state (pre-menopausal and post-menopausal). In-hospital outcomes were analyzed: 148 patients (60.4%) were post-menopausal. These patients were older (57 [52-66] vs. 49 [44-54] years, p<0.01) and had more often hypertension (49% vs. 27%, p<0.01) and dyslipidemia (46% vs. 25%, p<0.01). Post-menopausal women showed more often previous history of ACS, including previous SCAD (9% vs. 3%, p=0.046), and presented less frequently as ST-segment elevation myocardial infarction on admission, compared to pre-menopausal women (34% vs. 49%, p=0.014). On the other hand, premenopausal women showed more often proximal and multi-segment involvement (24% vs. 7%, and 32% vs. 18%, respectively, both p<0.01). Postmenopausal women were more often managed conservatively (85% vs. 71%, p<0.01) and presented less frequently left ventricular dysfunction (both, p<0.01). There were no differences between groups in terms of in-hospital stay or mortality, new acute myocardial infarction, unplanned coronary angiography or heart failure. In conclusion, postmenopausal women with SCAD show different clinical and angiographic characteristics compared with pre-menopausal SCAD patients. Initial treatment strategy was different between groups, though in-hospital outcomes did not significantly differ (NCT03607981).