Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction, particularly among women, with limited data on pregnancy-associated SCAD (P-SCAD). This cohort study, published in JAMA Cardiology, analyzed data from the multicenter iSCAD Registry (2019–2024), comparing women with P-SCAD and non–pregnancy-associated SCAD (NP-SCAD), along with reproductive health variables relative to the general reproductive-aged US population. 

A total of 907 women with SCAD and at least one prior pregnancy were included, with survey-derived reproductive and clinical data corroborated by extracted imaging and clinical records.
Among participants, 98 women had P-SCAD, with a younger median age at SCAD event (36.7 years) compared with the overall cohort. 

Women with P-SCAD demonstrated lower prevalence of fibromuscular dysplasia (31% vs 45%; P=0.01), while extracoronary abnormalities were similar between groups. Reproductive characteristics differed, with higher rates of assisted reproductive technology (26% vs 12%), multigravida status exceeding five gestations (13% vs 7%), and preeclampsia (25% vs 13%; P=0.001) observed in P-SCAD. 

Clinical presentation was more severe in P-SCAD, including higher rates of ST-segment elevation myocardial infarction (STEMI) (18.6% vs 5.5%; P<0.001), multivessel involvement (31% vs 17%; P=0.004), and left ventricular ejection fraction (LVEF) <40% (27% vs 7%; P=0.006). Recovery of LVEF at 1 year was less frequent in P-SCAD. Most patients in both groups were managed conservatively.

P-SCAD demonstrates distinct reproductive and clinical characteristics compared with NP-SCAD. These findings highlight a higher-risk phenotype with differences in cardiac recovery.