Depression Linked to Poor Cardiovascular Outcomes in Spontaneous Coronary Artery Dissection

Comorbid depression in patients with spontaneous coronary artery dissection (SCAD) is linked to a significantly increased risk of several adverse cardiovascular outcomes, according to findings from a recent study.1

The data were presented at the 9th Annual Heart in Diabetes Conference in Philadelphia, Pennsylvania, by Abena Korwaa Agyekum, MD, an internal medicine resident at SUNY Downstate, and suggest depression screening should be incorporated into routine SCAD care to improve outcomes.1

SCAD, which predominantly affects postpartum or postmenopausal women, occurs when an artery wall suddenly tears. Often, SCAD patients have few or no risk factors for heart disease, but SCAD can cause a life-threatening heart attack. Known risk factors for SCAD include pregnancy, postpartum state, concomitant FMD, arteriolopathies, and physical and emotional stressors.2,3

“SCAD is a major cause of acute coronary syndrome in young women without traditional risk factors,” Agyekum and colleagues wrote.1 “Depression is common among SCAD survivors, but its impact on clinical outcomes is poorly understood.”

To address this gap in research, investigators conducted a retrospective cohort study using data from the TriNetX Research Network to identify patients with SCAD with and without depression based on ICD-10 codes. During a 5-year follow-up, investigators compared all-cause mortality, heart failure, atrial fibrillation, cardiogenic shock, cerebrovascular disease, acute kidney injury, and pacemaker implantation between the propensity-matched groups, which each comprised 3247 patients.1

Results showed that although there was no significant difference between the groups for all-cause mortality, depression was associated with significantly increased rates of several cardiovascular outcomes, including:

• Heart failure (16.8% vs 12.2%; risk ratio [RR], 1.376; 95% CI, 1.191-1.591; P <.001)
• Cerebrovascular disease (12.8% vs 9.9%; RR, 1.287; 95% CI, 1.104-1.501; P = .001)
• Acute kidney injury (9.8% vs 5.5%; RR, 1.768; 95% CI, 1.453-2.152; P <.001)
• Atrial fibrillation (7.0% vs 5.4%; RR, 1.288; 95% CI, 1.045-1.588; P = .017)

Based on these data, investigators suggest that depression screening be implemented into routine SCAD care, highlighting the potential benefits of a multidisciplinary approach combining cardiovascular and mental health care. Additionally, they note SCAD patients with depression should receive enhanced monitoring for cardiovascular complications as well as early intervention strategies targeting depression.1

Despite several strengths of the present research, including the use of large propensity-matched cohorts, multi-institutional data, comprehensive outcome assessment, and a 5-year follow-up period, investigators outlined several potential limitations to these findings as well. These included the retrospective study design, the potential for residual confounding, limited data on medication adherence, and variable clinical practices.1

Looking ahead, the investigative team describes their desire for future prospective studies examining the impact of depression treatment on SCAD outcomes as well as investigation into the biological mechanisms linking depression and SCAD complications.1

References

1. Agyekum AK, Essien E, Nwaezeapu K, et al. #0087 Impact of Depression on Clinical Outcomes Among Spontaneous Coronary Artery Dissection Patients A Propensity-Matched Analysis Using the TriNetX Research Network. Abstract presented at the 9th Annual Heart in Diabetes Conference in Philadelphia, PA, from June 6 - 8, 2025.

2. American Heart Association. Coronary Artery Dissection: Not Just a Heart Attack. December 11, 2024. Accessed June 8, 2025. https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks/coronary-artery-dissection-not-just-a-heart-attack

3. Nepal S, Chauhan S, Bishop MA. Spontaneous Coronary Artery Dissection. StatPearls. June 21, 2023. Accessed June 8, 2025. https://www.ncbi.nlm.nih.gov/books/NBK582143/