New Zealand joins world-first trial to improve treatment for rare heart condition in women

Published: 12 May 2026

A major international research effort has kicked off to improve treatment for a rare cause of heart attacks that mainly affects women, with New Zealand playing an important role.

The Heart Foundation is supporting the Green Lane Cardiovascular Research Unit at Te Toka Tumai Auckland as part of a large global consortium study into spontaneous coronary artery dissection (SCAD), the first trial to investigate the best antiplatelet (blood‑thinning) treatment strategy for this condition. This New Zealand work is one part of a wider trial led from Germany and involving partners from nine countries. 

SCAD is a rare cause of heart attacks where blood flow to the heart muscle is reduced or cut off. It mainly affects women aged between 30 and 55 and usually happens without the typical “clogged artery” (atherosclerosis) seen in most heart attacks. SCAD is thought to cause about 1–2% of heart attacks, which equates to around 200 cases a year in New Zealand, with 90% occurring in women. 

For many years, SCAD was often missed or misdiagnosed, partly because it affects people who do not always fit the “typical” heart attack profile. It is now being picked up more often thanks to better imaging of the heart arteries. 

The international consortium is now launching the SCAD‑ALIGN trial, the first randomised study to systematically compare two antiplatelet treatment strategies in patients with SCAD. 

Cardiologists Dr Jocelyne Benatar and Professor Harvey White will lead the New Zealand arm of the study and aim to randomise around 50 patients with SCAD into the trial. 

Unlike most heart attacks, SCAD is usually not caused by a cholesterol‑blocked artery and blood clot. Instead, bleeding occurs within the wall of a coronary artery, causing the vessel layers to split and reduce or block blood flow, leading to symptoms such as chest pain or shortness of breath. Many people with SCAD have no history of heart problems or the usual risk factors doctors look for, and in many cases it happens after a period of physical or emotional stress, particularly in women. 

Among women under 50 who have a heart attack, around half are found to have SCAD, and it is also the leading cause of heart attacks during pregnancy. SCAD can come back too, with about 20% of patients having another event over several years. 

What the trial is testing 

The SCAD‑ALIGN study is looking at an important difference between SCAD and more typical heart attacks. In a usual heart attack, a blood clot blocks an artery and doctors often put in a stent (a small metal tube) and then use strong blood‑thinning (antiplatelet) medicines to stop more clots forming. 

With SCAD, the problem is different, as there is a tear or bleeding in the wall of the artery itself. In this situation, very strong blood‑thinning treatment might actually slow down healing or make the bleeding worse, which could make the condition more serious. 

Because of this, the SCAD‑ALIGN trial is testing whether a gentler approach to antiplatelet (blood‑thinning) therapy might be safer and just as effective for people with SCAD. The trial will compare two options: one blood‑thinning medicine for three months, versus two blood‑thinning medicines for three months followed by one medicine for another nine months. 

The aim is to work out which treatment gives people with SCAD the best chance of avoiding further heart problems, without increasing the risk of bleeding. 

“We usually treat patients with SCAD the same way as other patients having heart attacks,” says Dr Jocelyne Benatar. “With the SCAD‑ALIGN trial, we aim to determine which form of antiplatelet therapy really benefits patients and which may cause harm.” 

Heart Foundation Medical Director Dr Gerry Devlin says the trial will have a significant impact for thousands of people globally. 

“SCAD is a condition we still don’t fully understand, and there’s very little guidance for clinicians on how to treat it safely. 

“The results of this research will provide the clarity we’ve been waiting for with respect to antiplatelet therapy and will inform international best practice treatment guidelines, meaning thousands of women around the world, including here in New Zealand, will benefit from safer, more effective care.” 

The study is conducted by a consortium of ten international academic organisations within the Global Cardiovascular Research Funders Forum (GCRFF).