Serbian Study Reveals Alarming Risks of Rare Heart Tears in Women

A new study from the Serbian SCAD Registry has shed light on a rare but serious heart condition. Spontaneous coronary artery dissection (SCAD), a sudden tear in the coronary artery wall, often strikes young, healthy individuals—particularly women. The registry, led by Professor Svetlana Apostolović, tracked 123 patients over three years to better understand its causes, treatments, and outcomes.

Between November 2021 and November 2024, researchers collected data from 123 SCAD patients across Serbia. Of these, 27 cases were reviewed retrospectively, while 96 were followed in real time. The findings confirmed that SCAD overwhelmingly affects women, with 85.4% of patients being female and an average age of 47.5 years. Over a third were menopausal, reinforcing links between hormonal changes and the condition's risk.

Diagnosing SCAD remains challenging. Only about 25% of cases were confirmed using advanced intracoronary imaging, despite its growing importance. Unlike typical heart attacks caused by plaque buildup, SCAD involves a tear in the artery wall, creating a false passage or blood clot that blocks blood flow. This difference complicates both diagnosis and treatment decisions.

Treatment varied widely among patients. Percutaneous coronary intervention (PCI) was performed in 41.5% of cases, with stents placed in 28.5%. However, most patients (58.5%) received only medical therapy. Follow-up imaging after 30 days showed that 62.2% of dissections healed naturally, raising questions about the necessity of stents in all cases.

The study also highlighted serious risks. Nearly a quarter (23.6%) of patients suffered major cardiovascular complications during their hospital stay, and 8.1% died. These figures underscore the condition's severity, even among otherwise healthy individuals.

As of February 2026, Serbia remains the only Eastern European country outside Russia and Ukraine with a dedicated SCAD registry. No other nations in the region have established similar databases, leaving gaps in broader epidemiological research.

The Serbian SCAD Registry provides critical insights into a poorly understood condition that disproportionately affects women. With high rates of complications and natural healing observed in many cases, the findings may influence future treatment guidelines. The data also emphasises the need for broader regional registries to improve diagnosis and care for SCAD patients.