自発的冠動脈解離の急性期および慢性期管理

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized, non-atherosclerotic cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk factors. SCAD results from an intramural hematoma or intimal tear that compresses the coronary lumen, leading to myocardial ischemia. Diagnosis is critical, as management differs fundamentally from atherosclerotic ACS. Conservative therapy is preferred for hemodynamically stable patients due to high rates of spontaneous vessel healing; revascularization is reserved for ongoing ischemia, hemodynamic instability or left main/multivessel involvement. Long-term management focuses on reducing recurrence risk through β-blocker therapy, strict blood pressure control, and individualized cardiac rehabilitation. Although outcomes are generally favorable, recurrence occurs in up to 20% of patients. Ongoing research is needed to refine antiplatelet strategies, identify genetic and vascular risk factors, and optimize preventive care.