Derivation and Validation of Spontaneous Coronary Artery Dissection Prediction Score in Patients With Myocardial Infarction

Spontaneous coronary artery dissection (SCAD) is an important cause of acute myocardial infarction (AMI); however, the prevalence of SCAD and its predictors in AMI are unknown. We sought to derive and validate a simple score that can help predict SCAD in patients with AMI. We analyzed the Nationwide Readmissions Database and created a risk score for SCAD in patients with an index hospitalization for AMI. We used a multi-variate logistic regression analysis to determine the independent predictors of SCAD, and each was assigned points proportional to its regression coefficient. Among 1,155,164 patients with AMI, 8,630 (0.75%) had SCAD. Based on the derivation cohort, the indepen-dent predictors of SCAD were fibromuscular dysplasia (odds ratio [OR] 67.0, 95% confi-dence interval [CI] 42.0 to 107.9, p <0.01), Marfan or Ehlers-Danlos syndrome (OR 4.7, 95% CI 1.7 to 12.5, p <0.01), polycystic ovarian syndrome (OR 5.4, 95% CI 3.0 to 9.8, p <0.01), female gender (OR 1.99, 95% CI 1.9 to 2.1, p <0.01), and aortic aneurysm (OR 1.41, 95% CI 1.1 to 1.7, p <0.01). The SCAD risk score included fibromuscular dysplasia (5 points), Marfan or Ehlers-Danlos syndrome (2 points), polycystic ovarian syndrome (2 points), female gender (1 point), and aortic aneurysm (1 point). The C-statistics of the score were 0.58 (derivation cohort) and 0.61 (validation cohort). In conclusion, the SCAD score is an easy bedside clinical tool that can help clinicians identify patients with AMI who are at risk for SCAD. & COPY; 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;201:170-176)

Automated summary

Spontaneous coronary artery dissection (SCAD) is a significant cause of acute myocardial infarction (AMI), but its prevalence and predictors in AMI remain unknown. This study aimed to develop and validate a simple score for predicting SCAD in AMI patients. Using logistic regression analysis, independent predictors of SCAD were identified and assigned points. The SCAD risk score included fibromuscular dysplasia, Marfan or Ehlers-Danlos syndrome, polycystic ovarian syndrome, female gender, and aortic aneurysm. The score showed moderate predictive accuracy. In conclusion, the SCAD score is a practical tool for identifying AMI patients at risk for SCAD.