Ethnicity and its impact on presentation and outcomes in patients with spontaneous coronary artery dissection from the Australian-New Zealand registry

Hansaem Jung; Masoud S Haghighi; Quan Dang; Patrick Pender; Mithila Zaheen; David Makarious; Jaya Chandrasekhar; Peter J Psaltis; Jessica A Marathe; Sonya Burgess; Swati Mukherjee; Leonard Kritharides; Nigel Jepson; Sarah Fairley; Abdul Ihdayhid; Jamie Layland; Richard Szirt; Seif El-Jack; Aniket Puri; Esther Davis; Imran Shiekh; Ruth Arnold; Monique Watts; Hui Zhen Lo; Rohan Bhagwandeen; Edwina Wing-Lun; Ravinay Bhindi; Tom Ford; Sidney Lo; Kamran Majeed; Simone Marschner; Sarah Zaman

doi:10.1136/heartjnl-2026-327842

Ethnicity and its impact on presentation and outcomes in patients with spontaneous coronary artery dissection from the Australian-New Zealand registry

Heart. 2026 Apr 20:heartjnl-2026-327842. doi: 10.1136/heartjnl-2026-327842. Online ahead of print.

Authors

Hansaem Jung^{1

2}, Masoud S Haghighi^{3

2}, Quan Dang³, Patrick Pender^{3

4}, Mithila Zaheen^{3

5}, David Makarious^{3

5}, Jaya Chandrasekhar^{6

7}, Peter J Psaltis^{8

9}, Jessica A Marathe^{8

9}, Sonya Burgess^{2

10}, Swati Mukherjee¹¹, Leonard Kritharides^{2

12}, Nigel Jepson^{13

14}, Sarah Fairley¹⁵, Abdul Ihdayhid^{16

17}, Jamie Layland^{18

19}, Richard Szirt²⁰, Seif El-Jack²¹, Aniket Puri²², Esther Davis^{23

24}, Imran Shiekh²⁵, Ruth Arnold²⁶, Monique Watts^{27

28}, Hui Zhen Lo²⁹, Rohan Bhagwandeen³⁰, Edwina Wing-Lun^{2

31}, Ravinay Bhindi³², Tom Ford³³, Sidney Lo⁵, Kamran Majeed^{34

35}, Simone Marschner³, Sarah Zaman^{3

5}

Affiliations

¹ The University of Sydney Westmead Applied Research Centre, Westmead, New South Wales, Australia hjun3485@uni.sydney.edu.au.
² The University of Sydney Sydney Medical School, Sydney, New South Wales, Australia.
³ The University of Sydney Westmead Applied Research Centre, Westmead, New South Wales, Australia.
⁴ Department of Cardiology, Liverpool Hospital, Liverpool, New South Wales, Australia.
⁵ Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.
⁶ Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia.
⁷ Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia.
⁸ The University of Adelaide Adelaide Medical School, Adelaide, South Australia, Australia.
⁹ Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
¹⁰ Department of Cardiology, Nepean Hospital, Penrith, New South Wales, Australia.
¹¹ Department of Cardiology, Cabrini Hospital, Malvern, Pennsylvania, Australia.
¹² Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.
¹³ Department of Cardiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.
¹⁴ University of New South Wales Randwick Clinical Campus Prince of Wales Clinical School, Randwick, New South Wales, Australia.
¹⁵ Department of Cardiology, Wellington Hospital, Wellington, New Zealand.
¹⁶ Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
¹⁷ Curtin Medical School, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.
¹⁸ Department of Cardiology, Frankston Hospital, Frankston, Victoria, Australia.
¹⁹ Monash University Central Clinical School, Melbourne, Victoria, Australia.
²⁰ Department of Cardiology, St George Hospital, Kogarah, New South Wales, Australia.
²¹ Cardiovascular Unit, North Shore Hospital, Auckland, New Zealand.
²² Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.
²³ Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia.
²⁴ Department of Cardiology, Victorian Heart Hospital, Melbourne, Victoria, Australia.
²⁵ Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia.
²⁶ Orange Base Hospital, Orange, New South Wales, Australia.
²⁷ Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
²⁸ The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.
²⁹ Peninsula Health, Frankston, Victoria, Australia.
³⁰ Department of Cardiology, John Hunter Hospital, Newcastle, New South Wales, Australia.
³¹ Department of Cardiology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
³² Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
³³ Central Coast Clinical School, The University of Newcastle, Gosford, New South Wales, Australia.
³⁴ Waikato Hospital, Hamilton, New Zealand.
³⁵ Graduate School of Medicine, The University of Waikato, Hamilton, New Zealand.

PMID: 42009569
DOI: 10.1136/heartjnl-2026-327842

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is an uncommon but increasingly recognised, important cause of acute coronary syndrome (ACS) primarily described in European and North American populations, with ethnic differences poorly understood. We investigated the ethnic distribution of patients with SCAD and ethnic differences in major adverse cardiovascular events (MACEs).

Methods: This prospective and retrospective cohort study recruited adult patients with ACS and core-laboratory confirmed SCAD from 23 hospitals in Australia and New Zealand. Patients were analysed in four ethnic groups following the Australian Bureau of Statistics and Statistics New Zealand Standards for Ethnicity: white; Asian; Middle Eastern, North African, African (MENAA); and First Nations and Pacific Peoples. Predictors of MACEs were investigated with Cox proportional hazards models.

Results: Of 622 patients with SCAD, 488 (78.5%) were white, 45 (7.2%) Asian, 29 (4.7%) MENAA, 48 (7.7%) First Nations and Pacific Peoples and 12 (1.9%) Other. Of the analysed cohort (mean age 52.3±10.5 years, 87.9% female), MENAA patients had higher rates of pregnancy-associated SCAD (24% vs 2% overall, p<0.001) and lower chest pain rates (86% vs 96% overall, p=0.008). First Nations and Pacific Peoples had higher rates of bystander atherosclerosis (25% vs 16% overall, p=0.02). Asian patients had higher rates of non-fibromuscular dysplasia extracardiac vascular abnormalities (16% vs 5% overall, p=0.008). MACE-free survival was similar across ethnic groups, and ethnicity was not an independent predictor of MACE when adjusted for potential confounders.

Conclusions: This study is the first to describe the diverse ethnic distribution of patients with SCAD in the Australian-New Zealand-SCAD registry. Important ethnic differences include higher rates of pregnancy-SCAD in MENAA patients, and higher rates of bystander atherosclerosis in First Nations and Pacific Peoples patients. No ethnic difference was seen in MACE-free survival following SCAD.

Keywords: Acute Coronary Syndrome; Cohort Studies; Myocardial Infarction.