Spontaneous Coronary Artery Dissectionの探求：病態生理、診断、管理、および臨床的意義

Evidence is accumulating that shows spontaneous coronary artery dissection (SCAD) as a recognized cause of acute coronary syndrome (ACS), disproportionately affecting younger people and women. Moreover, despite continuing progress, the understanding of the pathophysiology, diagnosis, and management of SCAD remains limited. SCAD, by definition, is a non-atherosclerotic formation of an intramural hematoma or intimal tear, yet current diagnostic criteria and management are derived from atherosclerotic ACS guidelines. This review encompasses the current understanding of the condition, including risk factors, diagnostic and imaging modalities available for detection, differentials to be considered, associations with other comorbidities, prognostic factors, and management options for both the short and long term, encompassing both medical and interventional therapies. Meanwhile, a lack of research in key populations, such as non-pregnant women, postmenopausal women, and men, prevents the generalizability of these findings and has been highlighted. However, by identifying and conceptualizing existing evidence, this review aims to provide direction to future research.