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Spontaneous coronary artery dissection: A review for clinical and interventional cardiologists

Catarina Brízido1, Sérgio Madeira2, Cláudia Silva3

  • 1Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Department of Pathophysiology and Therapeutic Targets I, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|January 12, 2023
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) is a key cause of heart attacks in women. This review offers practical management strategies for SCAD, addressing diagnosis, treatment, and long-term care.

Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome (ACS).
  • It disproportionately affects young to middle-aged women with minimal traditional cardiovascular risk factors.
  • SCAD presents diagnostic and therapeutic challenges, particularly in pregnancy-associated cases.

Purpose of the Study:

  • To provide a practical management approach for SCAD patients.
  • To guide both clinical and interventional cardiologists in managing SCAD.
  • To highlight the importance of long-term follow-up and management of associated conditions.

Main Methods:

  • Review of current literature and clinical guidelines on SCAD.
  • Analysis of diagnostic modalities, focusing on invasive coronary angiography as the gold standard.
  • Evaluation of therapeutic strategies, including conservative management and revascularization.

Main Results:

  • Conservative therapy is generally recommended for SCAD.
  • Revascularization is reserved for specific high-risk scenarios.
  • Optimal medical therapy evidence is limited, especially for pregnancy-associated SCAD.
  • Recurrence is common, necessitating long-term lifestyle changes and pharmacological therapy.

Conclusions:

  • A structured, practical management approach is crucial for SCAD patients.
  • Long-term follow-up, lifestyle modifications, and addressing SCAD-associated conditions are essential.
  • Further research is needed to establish optimal medical therapies for SCAD.

Keywords:
Acute coronary syndromeDisplasia fibromuscularDissecção coronária espontâneaFibromuscular dysplasiaGravidezIntervenção coronária percutâneaMINOCAMinocaMulherPercutaneous coronary interventionPregnancySpontaneous coronary artery dissectionSíndrome coronária agudaWoman

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