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

Amin Daoulah 1, Salem M Al-Faifi 2, William T Hurley 3, Abdulaziz Alasmari 1, Mohammed Ocheltree 4, Rami H Abushanab 4, Hisham Hussein 5, Ahmed A Emam 6, Vikram Grewal 7, Zainab M Jafary 8, Ahmad S Hersi 9, Edward B Devol 10, Alawi A Alsheikh-Ali 11, Ali A Haneef 12, Amir Lotfi 13, G-Scad Investigators 14

Affiliations

doi: 10.2174/1573403X16999200817173944

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 is 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.

Keywords: SCAD; arabian gulf; coronary angiography; events; gender.; unemployment.

Figures

Fig. (1) Flow diagram of clinical presentation, angiographic finding, and acute management for SCAD patients who had developed in-hospital events. (A higher resolution / colour version of this figure is available in the electronic copy of the article).

Fig. (1) Flow diagram of clinical presentation, angiographic finding, and acute management for SCAD patients who had developed in-hospital events. (A higher resolution / colour version of this figure is available in the electronic copy of the article).

Fig. (2) Flow diagram of SCAD patients who had developed events during follow up. (A higher resolution / colour version of this figure is available in the electronic copy of the article).

Fig. (2) Flow diagram of SCAD patients who had developed events during follow up. (A higher resolution / colour version of this figure is available in the electronic copy of the article).

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