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