New research presented at the EAPCI Summit 2026 has provided updated information on spontaneous coronary artery dissection (SCAD), a condition that can cause heart attacks in young, otherwise healthy patients. The summit was organized by the European Association of Percutaneous Cardiovascular Interventions, part of the European Society of Cardiology.
SCAD occurs when an inner layer of a coronary artery separates from the outer layer, leading to blood accumulation between these layers. This process can reduce blood flow and trigger a heart attack. The majority of SCAD cases are seen in women who do not have typical risk factors for cardiovascular disease.
The analysis discussed at the summit was based on data from the Serbian SCAD Registry, which included 123 patients treated at 14 interventional cardiology centers between November 2021 and November 2024. Of these, 27 cases were studied retrospectively and 96 prospectively. Intracoronary imaging techniques helped confirm the diagnosis in just over a quarter of patients.
Women made up most of the patient group (85.4%), with an average age of 47.5 years. Among those affected, 6.7% were pregnant or had recently given birth, while more than one-third were menopausal. Common risk factors included high blood pressure and abnormal cholesterol levels. Mental stress was identified as a precipitating factor in nearly four out of ten cases where this information was available; physical stress played a role in about one out of ten.
Treatment approaches varied: percutaneous coronary intervention (PCI) was performed in about two out of five patients, including stent implantation for some; just under three out of five received only medical therapy. Over half received dual antiplatelet therapy and low-molecular weight heparin during their care.
While hospitalized, nearly one-quarter experienced major adverse cardiovascular events such as recurrent heart attacks or serious arrhythmias, and just over eight percent died. In the month following hospitalization, rates for such events remained significant but lower.
The study found that stent implantation and depression independently predicted worse outcomes after hospitalization. However, full resolution of SCAD occurred within thirty days for more than sixty percent of patients.
Professor Apostolović commented on these findings: "SCAD was most common in non-pregnant young women and menopausal women, with intracoronary imaging found to be particularly useful in enabling accurate diagnosis. SCAD often resolved fully and stent implantation was not beneficial in the majority of patients. Careful observation alongside beta-blockers, blood-pressure lowering medication, cardiac rehabilitation and psychological support may improve outcomes and reduce the impact on patients' daily lives, but more studies and trials are needed."
Ongoing research through larger multinational registries is expected to provide further understanding about how best to manage this condition.
