Spontaneous coronary artery dissection in an underrepresented region: insights from the Serbian (RS) SCAD registry

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Background: Evidence on spontaneous coronary artery dissection (SCAD) is largely derived from Western registries, with limited data from Eastern transitional regions. The Serbian SCAD Registry provides the first comprehensive multicenter data from this region. Methods: Patients with angiographically confirmed SCAD were enrolled from 14 PCI centers and followed during hospitalization, at 30 days, and at 1 year. Results: Among 123 patients (mean age 47.8 ± 11.8 years; 85.4% female), traditional cardiovascular risk factors were highly prevalent (hypertension 49.6%, dyslipidemia 46.3%, smoking 41.5%), exceeding rates reported in Western cohorts. Emotional stress was the most common precipitating factor (38.5%). Left anterior descending artery involvement occurred in 56.1%, with Type 2a SCAD being the most frequent (42.1%). PCI was performed in 51.3%, and dual antiplatelet therapy was prescribed in 87%, both substantially higher than in Western registries.In-hospital MACE occurred in 23.6% (mortality 8.1%). At 30 days, minor adverse events were observed, while one-year MACE was 8.2%. Conclusions: This Eastern European SCAD cohort demonstrates a distinct profile characterized by a high burden of traditional cardiovascular risk factors, frequent PCI use, and elevated in-hospital adverse events compared with Western registries. Greater adherence to guideline-based conservative management may improve outcomes.

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