Antiplatelet Therapy and Prognosis in Patients with Spontaneous Coronary Artery Dissection: A Single-Center Cohort Study

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Background: Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS), characterized by nontraumatic and noniatrogenic obstruction of the coronary artery lumen. Current knowledge claims that single antiplatelet therapy (SAPT) management is generally safe and preferred in stable patients, as thrombolytic and antiplatelet therapies may increase bleeding risk, promote extension of intramural hematoma, and delay vessel healing. However, evidence on the prognostic impact of SAPT in SCAD remains limited. This study aimed to characterize a consecutive cohort of SCAD patients in terms of clinical, sociodemographic, and angiographic features, and to evaluate the association between single versus dual antiplatelet therapy and adverse cardiac and hemorrhagic events. Methods: This is a single-center, retrospective, longitudinal observational study including 84 patients diagnosed with SCAD admitted between January 2010 and February 2024, accounting for 104 SCAD events. Patients were stratified by antiplatelet therapy at discharge: 37 received single antiplatelet therapy (SAPT) and 44 received dual antiplatelet therapy (DAPT). Adverse outcomes assessed included the composite outcome, which comprises SCAD/ACS recurrence, hospitalizations due to heart failure, stroke, and all-cause mortality. Hemorrhagic events were also evaluated in this study. Results: The median age was 55 years, and 83.3% of patients were women. Twenty-seven patients (32.2%) had at least one predisposing factor, the most frequent being multiparity ( n = 17, 21%). Sixteen patients (19%) had no identifiable cardiovascular risk factors. Non-ST-elevation myocardial infarction was the presenting manifestation in 64.3% of cases. The left anterior descending artery was most frequently affected (56%), and angiographic type 2 SCAD was the predominant pattern (77%). A conservative approach was the initial management strategy in most patients ( n = 67, 79.8%), while 17 (20.2%) underwent percutaneous coronary intervention. SCAD recurrence occurred in 17 patients. There was no statistically significant difference in baseline characteristics between the SAPT and DAPT groups. The group under DAPT association presented a higher occurrence of heart failure hospitalizations (SAPT: 0 [0.0%] vs. DAPT: 6 [13.6%], p = 0.029), with no significant difference in the composite outcome or occurrence of hemorrhagic events. Conclusion: Single antiplatelet therapy was not associated with an increased risk of adverse cardiac events when compared with dual antiplatelet therapy. These findings support a conservative antiplatelet approach in stable SCAD patients, suggesting that routine DAPT may not provide additional benefit for preventing recurrent cardiac events. Given the potential risks associated with dual therapy, including bleeding and delayed vessel healing, individualized antiplatelet strategies should be considered. Further prospective studies are needed to establish optimal antiplatelet regimens and to clarify the balance between thrombotic and hemorrhagic risks in SCAD. Publication History Article published online: 31 December 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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