New Zealand's research community is making headlines with its participation in a groundbreaking global clinical trial targeting spontaneous coronary artery dissection (SCAD), a rare yet serious heart condition predominantly affecting women. This trial represents a pivotal moment in cardiovascular research, particularly as it addresses a gap in treatments tailored specifically for women who suffer heart attacks without traditional risk factors like high cholesterol or smoking. Universities and hospitals across the country, including key players from the University of Auckland, are at the forefront, collaborating with international partners to enroll patients and gather critical data.

SCAD occurs when a tear develops in the wall of a coronary artery, allowing blood to pool and form a clot that blocks blood flow to the heart muscle. Unlike typical heart attacks caused by plaque buildup, SCAD strikes suddenly, often in otherwise healthy individuals. In New Zealand, this condition accounts for up to one-third of heart attacks in women under 50 and nearly half of those occurring during pregnancy. The sudden nature of SCAD makes it particularly alarming, as symptoms mimic standard heart attacks but require different management to avoid worsening the tear.

Challenges in Diagnosing and Treating SCAD in Women

Diagnosis of SCAD has historically been challenging due to its rarity and the tendency for clinicians to overlook it in young women presenting with chest pain. Advanced imaging techniques like intravascular ultrasound or optical coherence tomography are often needed to confirm the tear, but these are not routinely used. In New Zealand hospitals, many cases are initially misdiagnosed as anxiety or indigestion, delaying critical intervention.

Current treatments borrow from atherosclerotic heart disease protocols, primarily involving blood-thinning medications like aspirin. However, these antiplatelet therapies can exacerbate the dissection by increasing bleeding into the artery wall. Conservative management—bed rest and monitoring—heals many cases naturally, but recurrence rates remain high, with up to 20 percent of patients experiencing another event. This uncertainty underscores the urgency for evidence-based guidelines, which this trial aims to establish.

Women with SCAD face unique risks, including hormonal influences during peripartum periods or fibromuscular dysplasia, a related arterial condition. New Zealand data from ongoing registries highlight that Maori and Pacific women may be disproportionately affected, prompting calls for culturally sensitive research approaches.

The Global SCAD Trial: A World-First Randomized Study

Launched as the first-ever randomized controlled trial for SCAD, this international effort will recruit 3,250 patients across multiple countries to compare single antiplatelet therapy (aspirin alone) versus dual antiplatelet therapy (aspirin plus another agent like clopidogrel). The primary outcomes include recurrent heart attacks, bleeding complications, and quality of life measures. By standardizing treatments already in use, results could rapidly influence global guidelines from bodies like the American Heart Association and European Society of Cardiology.

The trial's design incorporates patient-reported outcomes, recognizing the psychological toll of SCAD, including anxiety and depression from unpredictable recurrences. Enrollment emphasizes diversity to ensure findings apply broadly, addressing past biases in cardiovascular research that underrepresented women.

New Zealand's Research Leadership: University of Auckland and Partners

At the heart of New Zealand's involvement is the University of Auckland's Green Lane Coordinating Centre, a hub for cardiovascular clinical trials. Senior clinical research scientist Dr. Caroline Alsweiler leads the local arm, securing funding from the Heart Foundation New Zealand as part of a $4.2 million grant package supporting 31 projects. This centre, affiliated with Auckland City Hospital, leverages expertise from the Manaaki Manawa Centre for Research Excellence, which focuses on heart health equity.

Other collaborators include Middlemore Hospital and Waikato Hospital, ensuring broad geographic representation. The University of Otago's cardiovascular research group provides epidemiological support, analyzing local incidence rates. This multi-institutional effort exemplifies how New Zealand universities foster collaborative, high-impact research despite limited resources.

Key Figures Driving the Research

Dr. Alsweiler's team builds on prior work from cardiologists like Professor Ralph Stewart, whose studies on acute coronary syndromes have informed SCAD registries. Clinical Director Dr. Gerry Devlin of the Heart Foundation emphasizes the trial's potential to shift paradigms, noting, "Treatments proven for men don't always translate to women— this trial changes that." Patient advocates from SCAD support groups contribute to trial design, ensuring real-world applicability.

University of Auckland's involvement extends to training early-career researchers, with PhD students analyzing imaging data. This pipeline strengthens New Zealand's capacity in women's cardiovascular health, aligning with national priorities for equity in Maori and Pacific communities.

Patient Recruitment and New Zealand's Contribution

New Zealand aims to recruit 50 patients, a significant commitment given the condition's rarity—estimated at 1-4 percent of all heart attacks locally. Eligible participants are women recently diagnosed via angiography, excluding those with traditional atherosclerosis. Recruitment occurs at major centers like Auckland, Hamilton, and Christchurch hospitals, with informed consent emphasizing trial benefits and risks.

• Screening via advanced imaging to confirm SCAD.
• Randomization to treatment arms within 48 hours of diagnosis.
• Follow-up for 12 months, including cardiac MRIs and lifestyle assessments.

This structured approach minimizes bias, providing robust data for subgroup analyses on ethnicity and comorbidities.

Broader Implications for Women's Heart Health Research

SCAD research highlights systemic gaps in cardiology, where women comprise only 30 percent of trial participants historically. New Zealand universities are pioneering solutions, integrating sex-specific analyses into studies like MENZACS (Multi-Ethnic New Zealand Study of Acute Coronary Syndrome). Complementary efforts, such as the SHE-HEALS menopause study, explore hormonal links to heart disease risk.

Locally, initiatives like women's heart clinics at Auckland Hospital offer specialized care, reducing misdiagnosis rates by 40 percent through multidisciplinary teams.

Photo by Alexandre Lecocq on Unsplash

Future Outlook: Transforming Treatment and Prevention

If successful, trial results could reduce recurrence by optimizing antiplatelet use, potentially saving lives and healthcare costs—SCAD hospitalizations cost NZ $10 million annually. Universities plan longitudinal follow-ups, exploring genetic factors via biobanks. Prevention strategies may include screening high-risk groups like postpartum women or those with connective tissue disorders.

New Zealand's role positions its researchers as global leaders, attracting funding and talent. For patients, it offers hope: clearer paths to recovery and reduced fear of sudden events.

For those interested in cardiovascular research careers, opportunities abound at institutions like the University of Auckland. This trial not only advances medicine but inspires the next generation of scientists focused on equity.