Spontaneous coronary artery dissection: update 2019

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Spontaneous coronary artery dissection (SCAD) is a critical cause of myocardial infarction (MI), particularly in women lacking traditional cardiovascular risk factors.
• Underdiagnosis and misdiagnosis are prevalent due to limited awareness among healthcare professionals, affecting a younger demographic.

Purpose of the Study:

• To review current data on the causes, management approaches, and outcomes associated with SCAD.
• To highlight the importance of accurate diagnosis and appropriate treatment strategies for SCAD patients.

Main Methods:

• Review of contemporary literature on SCAD.
• Analysis of diagnostic modalities including coronary angiography and intravascular imaging.
• Evaluation of treatment strategies, distinguishing between conservative management and revascularization.

Main Results:

• SCAD accounts for up to 4% of acute coronary syndromes, challenging previous notions of its rarity.
• Predisposing factors include fibromuscular dysplasia and vasculopathies; triggers involve physical or emotional stress.
• Conservative management is preferred for low-risk SCAD patients, while high-risk cases require prompt intervention.
• Recurrence of cardiovascular events after SCAD is common, necessitating close patient monitoring.

Conclusions:

• SCAD is an under-recognized cause of MI in women, requiring increased clinical awareness.
• Meticulous diagnostic techniques are crucial to prevent iatrogenic injury.
• A tailored approach to management, prioritizing conservative strategies for most, alongside vigilant follow-up, improves outcomes.