Impact of connective tissue disease features on patients with spontaneous coronary artery dissection

Sant Kumar; George Bcharah; Mahmoud Abdelnabi; Linnea M Baudhuin; Ramzi Ibrahim; Hussein Abdul Nabi; Girish Pathangey; Hend Bcharah; Estefana Bcharah; Yuxiang Wang; Mayo A Osundiji; Fadi E Shamoun

doi:10.1016/j.carrev.2025.06.023

Impact of connective tissue disease features on patients with spontaneous coronary artery dissection

Cardiovasc Revasc Med. 2025 Jun 21:S1553-8389(25)00308-2. doi: 10.1016/j.carrev.2025.06.023. Online ahead of print.

Affiliations

¹ Department of Cardiovascular Disease, Mayo Clinic Hospital, Phoenix, AZ, USA; Department of Cardiovascular Disease, Creighton University School of Medicine, Phoenix, AZ, USA.
² Department of Cardiovascular Disease, Mayo Clinic Hospital, Phoenix, AZ, USA.
³ Department of Cardiovascular Disease, Mayo Clinic Hospital, Phoenix, AZ, USA; Department of Clinical Genomics, Mayo Clinic Hospital, Phoenix, AZ, USA.
⁴ Department of Cardiovascular Disease, Mayo Clinic Hospital, Phoenix, AZ, USA; Department of Clinical Genomics, Mayo Clinic Hospital, Phoenix, AZ, USA. Electronic address: Shamoun.Fadi@mayo.edu.

PMID: 40579292
DOI: 10.1016/j.carrev.2025.06.023

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction, frequently associated with connective tissue disorder (CTD) features such as joint hypermobility and scoliosis. However, the clinical impact of these features in patients with SCAD remains poorly characterized. This study aimed to investigate the prevalence of CTD features among SCAD patients and evaluate their influence on adverse cardiovascular outcomes, including recurrent myocardial infarction, stroke, and mortality, to facilitate better risk stratification and targeted clinical management.

Methods: This retrospective study analyzed 1380 patients diagnosed with SCAD from Mayo Clinic sites (2018-2024). Patients were stratified based on the presence or absence of CTD features identified through ICD-10 codes and manual chart review. The primary composite outcome included recurrent MI, stroke, and all-cause mortality. Univariable and multivariable logistic regression models were utilized to identify independent predictors of adverse outcomes. Propensity score matching was employed to balance baseline characteristics, and Kaplan-Meier survival analysis assessed time-to-event outcomes.

Results: CTD features were observed in 26.7 % (368/1380) of SCAD patients, with joint conditions (20 %) being the most prevalent. Patients with CTD features exhibited significantly higher rates of the composite outcome than those without (57.9 % vs. 41.0 %, p < 0.001) in propensity-matched analysis. Joint conditions (OR: 3.19; 95 % CI: 2.17-4.68, p < 0.001) and grouped CTD features (OR: 2.77; 95 % CI: 2.01-3.82, p < 0.001) independently predicted worse outcomes. Recurrent MI specifically was significantly more frequent in patients with CTD features (55.3 % vs. 35.5 %, p < 0.001).

Conclusion: CTD features are common among SCAD patients and are associated with significantly higher rates of adverse cardiovascular outcomes, notably recurrent MI. Recognizing CTD features in SCAD patients could enhance risk stratification and inform targeted management strategies.

Keywords: Connective tissue diseases; Connective tissue features; Major adverse cardiovascular events; Spontaneous coronary artery disease.