Diagnostic Delays in Patients with MI from Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is an important but under-recognized cause of acute coronary syndromes, particularly among young women without traditional cardiovascular risk factors. The 2018 American Heart Association statement on management of SCAD recommends early diagnosis for this condition because treatment differs from typical acute coronary syndromes due to atherosclerotic disease. Members of the UT Southwestern Division of Cardiology have a particular interest in SCAD and have participated in the International SCAD (iSCAD) Registry, a robust collaboration of SCAD researchers around the globe.

At #AHA22, we presented an analysis from the iSCAD Registry that focused on diagnostic delays among SCAD patients. We were interested in understanding delays in patient presentation to the hospital after onset of symptoms, as well as delays in establishing a definitive diagnosis with a coronary angiogram once patients were admitted to the hospital. Delays in patient presentation to the hospital and in coronary angiography were defined as more than 24 hours from onset of symptoms or presentation to the hospital, respectively.

A total of 346 patients with acute MI secondary to SCAD were included in this study, 34% of whom presented with a STEMI and 15% of whom were non-white. Most patients (84%) presented to the hospital within 24 hours of symptom onset. No patient-specific factors, such as demographics, educational background, or medical history, were associated with a delay in presentation to the hospital after symptom onset. A total of 260 patients (75%) underwent early angiography. Presenting with a STEMI was associated with early angiography, as would be expected. Non-white race was associated with a delay in performing invasive coronary angiography after hospital admission. This association was not explained by disease severity at the time of presentation. Patients who had early angiography were more likely to undergo percutaneous coronary intervention, presumably related to the higher proportion of STEMI patients in this group. Similarly, patients undergoing delayed angiography were less likely to undergo percutaneous intervention and also were less likely to receive dual antiplatelet therapy at discharge. In-hospital outcomes were similar between those who underwent early or delayed angiography.

In summary, we were unable to identify patient-related factors that predicted a delay in presentation to the hospital following onset of symptoms in patients with AMI due to SCAD. In contrast, non-white race was associated with a delay in performing invasive coronary angiography in this setting. Further investigation is required to delineate the cause of this potential disparity in care.