Recurrent Acute Coronary Syndrome in Spontaneous Coronary Artery Dissection: Beyond the Guidelines
Anudeep Nakirikanti1, Calla Khilnani1, Omar Al Dhaybi2
1Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Spontaneous coronary artery dissection (SCAD) in vascular Ehlers-Danlos syndrome (vEDS) presents management challenges. A heart team approach is crucial for guiding treatment decisions in recurrent acute coronary syndrome (ACS) cases.
Area of Science:
- Cardiology
- Genetics
- Vascular Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) is a significant cause of acute coronary syndrome (ACS).
- Vascular Ehlers-Danlos syndrome (vEDS) is a known risk factor for SCAD.
- Recurrent ACS in vEDS-associated SCAD poses complex management dilemmas.
Background:
Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome (ACS) in vascular Ehlers-Danlos syndrome (vEDS).
Case Summary:
A 35-year-old with vEDS, found to have SCAD on coronary computed tomography angiography, was admitted with recurrent episodes of ACS. After each event, a heart team recommended medical management, eventually leading to resolution of symptoms without the need for invasive revascularization. WHY BEYOND THE GUIDELINES?: There are few guidelines for the management of recurrent ACS in the setting of SCAD, and clinicians are left without concrete recommendations for these high-risk clinical scenarios.
Discussion:
ACS management in vEDS-associated SCAD is made challenging by limited evidence to guide risk stratification, and it remains difficult to identify patients who will require revascularization vs those who can be medically managed.
Take-Home Message:
In the absence of evidence-based guidelines, SCAD management should be guided by a heart team approach.
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