Medical therapy in spontaneous coronary artery dissection: the role of beta-blockers and statins
J Conde Goncalves, L Alves, B Viana, T Branco, E Figueiredo, B Cruz, E Oliveira, A Cabrita, M PaivaAbstract
Background
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes, predominantly affecting women without traditional atherosclerotic risk factors. Optimal long-term medical therapy remains uncertain, particularly regarding the role of beta-blockers (BB) and statins in preventing recurrence and adverse cardiovascular events.
Purpose
To evaluate the clinical characteristics, angiographic findings, and long-term outcomes associated with beta-blocker and statin therapy in patients with SCAD.
Methods
We retrospectively analyzed consecutive patients with angiographically confirmed SCAD admitted between November 2009 and August 2025 at a tertiary cardiology center. Demographic, clinical, angiographic, and follow-up data were collected. Patients were categorized based on BB and statin prescription at discharge. Associations between categorical variables were assessed using Fisher’s exact test. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular death, myocardial infarction, stroke, or heart failure hospitalization.
Results
The 64-patients cohort was predominantly female (93.8%), with a median age of 51 years (IQR 44–64). At discharge, 79.7% of patients received BB—bisoprolol (70.3%) and carvedilol (9.4%)—and 68.6% were prescribed statins, mainly atorvastatin (48.5%), followed by rosuvastatin (11.1%) and simvastatin (11.0%). During a median follow-up of 69 months (IQR 33–117), MACE occurred in 14.1% of patients, with no significant difference between those treated with BB and those not treated (p=0.65). Recurrent ischemic events occurred in 10.9% and were not significantly associated with BB therapy (p=0.61). A trend toward greater left ventricular recovery was observed among BB-treated patients (86.7% vs. 66.7%; p=0.78). Regarding statin therapy, MACE occurred in 12.9% of patients and showed no significant difference between those treated and not treated with statins (p=1.00). Similarly, recurrent ischemic events occurred in 10.9%, with no significant association with statin therapy (p=1.00).
Conclusion
In this cohort of SCAD patients, neither beta-blocker nor statin therapy at discharge was significantly associated with lower rates of MACE or recurrent ischemic events during long-term follow-up. Beta-blockers were widely prescribed, reflecting current observational evidence suggesting a potential protective role, although definitive data are still lacking. Statin therapy was also frequently used, yet its benefit in SCAD remains uncertain given the non-atherosclerotic underlying pathophysiology. These findings highlight the need for prospective, dedicated studies to define evidence-based medical management in SCAD.