Related Experiment Video
Updated: Sep 21, 2026
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
A review of the risk and precipitating factors for spontaneous coronary artery dissection
Dragana Stanojevic1, Svetlana Apostolovic1,2, Tomislav Kostic1,2
1Clinic for Cardiology, University Clinical Center Nis, Nis, Serbia.
Insights
Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome (ACS), predominantly affecting women. Understanding its non-traditional risk factors is key for accurate diagnosis and timely treatment.
Area of Science:
- Cardiology
- Vascular Biology
Background:
- Spontaneous coronary artery dissection (SCAD) accounts for 1%-4% of acute coronary syndrome (ACS) cases.
- SCAD involves separation of the coronary artery wall layers, leading to intramural hematoma or false lumen formation, causing myocardial ischemia or infarction.
- SCAD incidence is significantly higher in women (9:1 ratio), particularly during pregnancy and the peripartum period, and is often associated with non-traditional risk factors.
Purpose of the Study:
- To highlight the distinct risk factor profile of SCAD compared to atherosclerotic coronary artery disease.
- To present common non-traditional risk factors associated with SCAD.
- To emphasize the importance of considering SCAD in patients with low cardiovascular risk presenting with ACS symptoms, especially women.
Main Methods:
- Literature review and analysis of patient data associated with SCAD.
- Identification and categorization of predisposing and precipitating factors for SCAD.
- Comparison of risk factors in SCAD patients versus those with atherosclerotic coronary artery disease.
Main Results:
- SCAD is more prevalent in women, with hypertension being a rare traditional risk factor.
- Commonly associated conditions include fibromuscular dysplasia, inherited connective tissue disorders, pregnancy, hormone use, substance abuse, and thyroid disorders.
- Precipitating factors differ between sexes, with emotional stress more common in women and physical stress in men; anxiety and depression are frequently reported by women with SCAD.
Conclusions:
- SCAD should be considered in patients presenting with ACS symptoms and low cardiovascular risk, particularly in women.
- Recognizing SCAD and its associated non-traditional risk factors is crucial for timely diagnosis and management.
- Differences in clinical presentation and risk factors between men and women with SCAD warrant further investigation.
Introduction:
Spontaneous coronary artery dissection (SCAD) accounts for 1%-4% of cases of acute coronary syndrome (ACS). SCAD is caused by separation occurring within or between any of the three tunics of the coronary artery wall. This leads to intramural hematoma and/or formation of false lumen in the artery, which leads to ischemic changes or infarction of the myocardium. The incidence of SCAD is higher in women than in men, with a ratio of approximately 9:1. It is estimated that SCAD is responsible for 35% of ACS cases in women under the age of 60. The high frequency is particularly observed during pregnancy and in the peripartum period (first week). Traditional risk factors are rare in patients with SCAD, except for hypertension. Patients diagnosed with SCAD have different combinations of risk factors compared with patients who have atherosclerotic changes in their coronary arteries. We presented the most common so-called "non-traditional" risk factors associated with SCAD patients.
Risk Factors And Precipitating Disorders Which Are Associated With Scad:
In the literature, there are few diseases frequently associated with SCAD, and they are identified as predisposing factors. The predominant cause is fibromuscular dysplasia, followed by inherited connective tissue disorders, systemic inflammatory diseases, pregnancy, use of sex hormones or steroids, use of cocaine or amphetamines, thyroid disorders, migraine, and tinnitus. In recent years, the genetic predisposition for SCAD is also recognized as a predisposing factor. The precipitating factors are also different in women (emotional stress) compared with those in men (physical stress). Women experiencing SCAD frequently describe symptoms of anxiety and depression. These conditions could increase shear stress on the arterial wall and dissection of the coronary artery wall. Despite the advancement of SCAD, we can find significant differences in the clinical presentation between women and men.
Conclusion:
When evaluating patients with chest pain or other ACS symptoms who have a low cardiovascular risk, particularly female patients, it is important to consider the possibility of ACS due to SCAD, particularly in conditions often associated with SCAD. This will increase the recognition of SCAD and the timely treatment of affected patients.
More Related Videos
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
13:07Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:26Coronary Artery Disease IV: Preventive Measures
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies