Spontaneous Coronary Artery Dissection: Does Being Unemployed Matter? Insights from the GSCAD Registry

Abstract

Background: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) and sudden cardiac death. Physical or emotional stressors are the most commonly reported triggers for SCAD. Unemployment has been identified as a source of emotional stress and linked to poor mental and physical health. Objective: To examine the association between employment status and in-hospital and follow-up adverse cardiovascular events in patients with SCAD. Methods: We conducted a retrospective, multi-center, observational study of patients undergoing coronary angiography for ACS between January 2011 and December 2017. The total number of patients enrolled was 198,000. Patients were diagnosed with SCAD based on angiographic and intravascular imaging modalities whenever available. There were 83 patients identified with SCAD from 30 medical centers in 4 Arab gulf countries. In-hospital (myocardial infarction, percutaneous intervention, ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, internal cardioverter/defibrillator placement, dissection extension) and follow-up (myocardial infarction, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were compared among those who were employed and those who were not. Results: The median age of patients in the study was 44 (37- 55) years. There were 42 (50.6%) female patients, and 41 (49.4) male patients. Of the cohort, 50 (60%) of the patients were employed and the remaining 33 (40%) were unemployed. 66% of all men were employed and 76% of all women were unemployed. After adjusting for gender unemployment was associated with worse in-hospital and follow-up cardiac events (adjusted OR 7.1, [1.3, 37.9]), p = 0.021. Conclusion: Adverse cardiovascular events were significantly worse for patients with SCAD who were unemployed.

Spontaneous Coronary Artery Dissection in the Setting of COVID-19 Pandemic-Related Stressors: A Case Report

“…Therefore, women presenting with MI in the setting of recent significant emotional stress should further raise clinical suspicion of SCAD. There is also some evidence that unemployment is a stressor significantly associated with SCAD, as patients with recent unemployment-related stress suffered worse in-hospital and follow-up cardiac events compared to those with other stressors [ 4 , 5 ].…”

“…A large proportion of patients with SCAD report significant emotional stress immediately before the event and are more likely than patients with atherosclerosis-related ACS to report such stressors [ 2 , 3 ]. Furthermore, unemployment has been shown to be a significant stressor in patients with SCAD and is associated with worse in-hospital and follow-up cardiac events [ 4 , 5 ]. In the setting of increased stresses and unemployment during the COVID-19 pandemic, we present this case of a SCAD in a female with impending unemployment due to pandemic-related factors.…”

Diseksi Spontan Arteri Koroner: Diagnosis dan Manajemen

“…Henti jantung, aritmia ventrikuler, penggunaan steroid, dan atrial fibrilasi didapatkan dapat menjadi prediktor terjadi kematian pasien SCAD di rumah sakit [18]. Kejadian MACE lebih sering terjadi pada orang yang tidak memiliki pekerjaan [42].…”

Regional and temporal variations of spontaneous coronary artery dissection care according to consensus recommendations: a systematic review and meta-analysis

“…Due to heterogeneity, meta-analysis was not performed for this parameter. Daoulah et al, 2020 16 Daoulah et al, 2021 17 Daoulah et al, 2021 18 Daoulah et al, 2021 19 Daoulah et al, 2021 20 Gulf SCAD Registry Daoulah et al, 2021 20 Latest study Saw et al, 2014 21 Saw et al, 2017 22 Saw et al, 2019 23 Canadian SCAD Registry Saw et al, 2019 23 Latest study with highest number of patients…”