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Spontaneous Coronary Artery Dissection (SCAD) from an Interventionalist Perspective.

Nichole Brunton1, Patricia J M Best2, Kimberly A Skelding3

  • 1Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.

Current Cardiology Reports
|January 18, 2024
PubMed
Summary

Spontaneous coronary artery dissection (SCAD) is a key cause of heart attacks in women. Current evidence supports conservative management for SCAD, with invasive strategies reserved for specific complications.

Keywords:
Extracoronary vascular abnormalitiesPercutaneous coronary interventionSpontaneous coronary artery dissectionWomen’s cardiovascular health

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Area of Science:

  • Cardiology
  • Vascular Biology
  • Women's Health

Background:

  • Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome (ACS).
  • SCAD disproportionately affects women under 50.
  • SCAD can be an early indicator of systemic arterial disease.

Purpose of the Study:

  • To review the pathogenesis of SCAD.
  • To discuss SCAD as a manifestation of systemic arterial disease.
  • To highlight management strategies and challenges in women with SCAD.

Main Methods:

  • Literature review of SCAD pathogenesis, clinical presentation, and management.
  • Analysis of current treatment paradigms, including conservative vs. invasive approaches.
  • Identification of specific patient populations at higher risk.

Main Results:

  • A shift towards conservative management for SCAD is evident.
  • Invasive interventions are reserved for hemodynamically unstable patients due to higher risks.
  • Premenopausal women, those with connective tissue disease, and pregnancy-associated SCAD (P-SCAD) represent high-risk groups.

Conclusions:

  • Conservative management is the current standard for SCAD.
  • Further research is needed on genetic factors, optimal medical therapy, and interventional techniques.
  • Evidence-based data on SCAD, particularly in women, remains limited.