Spontaneous Coronary Artery Dissection: Latest Developments and New Frontiers

Area of Science:

• Cardiology
• Vascular Biology
• Women's Health

Background:

• Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction, especially in women.
• Predisposing factors include fibromuscular dysplasia, hormonal therapy, multiparity, connective tissue disorders, and systemic inflammatory diseases.

Purpose of the Study:

• To review current knowledge and recent developments in SCAD epidemiology, presentation, diagnosis, and management.
• To summarize findings from contemporary observational studies and clinical series.

Main Methods:

• Review of published observational studies and contemporary series on SCAD.
• Analysis of diagnostic advancements, including novel angiographic classification and intravascular imaging (OCT, IVUS).
• Evaluation of management strategies, long-term medical therapy (beta-blockers), and outcomes from large patient cohorts.

Main Results:

• SCAD accounts for up to 4% of acute coronary syndrome (ACS) presentations.
• Complications like cardiogenic shock and cardiac arrest are not uncommon, with higher incidence in peripartum women.
• Conservative management is often successful, with low rates of percutaneous coronary intervention success; beta-blockers reduce recurrence.
• SCAD-specific cardiac rehabilitation offers long-term cardiovascular benefits.

Conclusions:

• SCAD awareness and research have surged, aided by patient networks and core lab data interpretation.
• Further research into SCAD pathogenesis, improved therapies, and complication management is crucial.
• Centralized data and collaborative efforts are advancing the understanding and treatment of SCAD.