On the provenance of spontaneous coronary artery dissection
Robert M Graham1,2,3,4, Sharonne N Hayes5, Lucy McGrath-Cadell1,2
1Victor Chang Cardiac Research Institute, 405 Liverpool Street, Darlinghurst, NSW 2010, Australia.
Insights
Spontaneous coronary artery dissection (SCAD) is a rare cause of heart attack, primarily affecting younger women. Recent advancements in imaging have increased its diagnosis, revealing it as distinct from atherosclerotic heart disease.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS).
- SCAD predominantly affects women (over 90% of cases), typically aged 45-52 years, and is a leading cause of myocardial infarction in pregnancy.
- Improved imaging techniques like intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) aid in diagnosing SCAD.
Purpose of the Study:
- To explore the historical origins and evolving understanding of spontaneous coronary artery dissection.
- To differentiate SCAD from other causes of coronary artery dissection, such as atherosclerosis or trauma.
Main Methods:
- Review of medical literature dating back to 1800.
- Analysis of diagnostic criteria and understanding of SCAD over time.
- Comparison of SCAD with atherosclerotic and iatrogenic coronary artery dissection.
Main Results:
- SCAD is characterized by spontaneous bleeding within the tunica media of coronary arteries, leading to intramural hematoma.
- The recognition of SCAD as an idiopathic condition, separate from atherosclerosis or trauma, is a recent development (last 10-15 years).
- SCAD diagnosis is facilitated by advanced imaging modalities.
Conclusions:
- The definition and understanding of SCAD have significantly evolved, highlighting its idiopathic nature.
- Distinguishing SCAD from other coronary dissections is crucial for appropriate management.
- Further research into the provenance of SCAD is warranted.
Abstract:
Spontaneous coronary artery dissection is an unusual, but increasingly recognized, cause of acute coronary syndrome. It is a potentially fatal disorder that predominantly (>90% of cases) affects women, who are about 20 years younger (age 45-52 years) than those presenting with an acute coronary syndrome due to atherosclerotic coronary artery disease, and is the commonest cause of myocardial infarction associated with pregnancy. With the advent of improved coronary artery imaging modalities, including invasive coronary angiography, intravascular ultrasonography (IVUS), and optical coherence tomography (OCT), spontaneous coronary artery dissection is being increasingly diagnosed. It is typically due to a spontaneous bleed in the tunica media of an epicardial coronary artery, with or without an intimal tear, that results in an intramural haematoma; the latter, in turn causing a separation or dissection of the lamellae formed by the layers of smooth muscle cells of the tunica media, which can propagate longitudinally. Although coronary artery dissection can be due to atherosclerotic disease that may, in fact, present spontaneously, or to trauma, or guidewire-induced intimal injury, the understanding that the entity now known as spontaneous coronary artery dissection is an idiopathic disorder that is not associated with atherosclerosis or trauma, and is not iatrogenic, is one that has emerged only relatively recently (last 10-15 years). This raises the question, what is the provenance of spontaneous coronary artery dissection as it is now defined and understood? Here, this issue is addressed by a detailed consideration of the medical literature from 1800.
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