Acute and Chronic Management of Spontaneous Coronary Artery Dissection

Area of Science:

• Cardiology
• Vascular Biology

Background:

• Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome (ACS).
• It predominantly affects younger women lacking traditional cardiovascular risk factors.
• SCAD involves intramural hematoma or intimal tears, causing coronary lumen compression and myocardial ischemia.

Purpose of the Study:

• To highlight the diagnostic importance of SCAD.
• To outline current management strategies for SCAD.
• To discuss long-term care and recurrence prevention in SCAD patients.

Main Methods:

• Review of SCAD pathophysiology and clinical presentation.
• Analysis of diagnostic criteria and imaging modalities.
• Evaluation of conservative versus revascularization treatment approaches.
• Assessment of long-term management and risk factor modification.

Main Results:

• SCAD diagnosis is critical as management differs from atherosclerotic ACS.
• Conservative therapy is favored for stable patients due to high spontaneous healing rates.
• Revascularization is reserved for specific indications like ongoing ischemia or left main involvement.
• Long-term management includes beta-blockers, blood pressure control, and cardiac rehabilitation.

Conclusions:

• SCAD outcomes are generally favorable, but recurrence rates can reach up to 20%.
• Further research is needed for optimal antiplatelet strategies and identification of genetic/vascular risk factors.
• Optimizing preventive care is essential for SCAD patients.