Spontaneous coronary artery dissections
Summary
Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndromes (ACS). It predominantly affects young or middle-aged women including a small proportion who are pregnant or post-partum. Accurate diagnosis is critical as optimal management differs from atherosclerotic ACS. Angiographic appearances of SCAD are usually distinct but ambiguous cases may require other investigations, particularly intracoronary imaging. Percutaneous coronary intervention (PCI) is associated with an increased risk of complications in SCAD and should be reserved for cases where a conservative revascularisation strategy is not possible. Mortality after SCAD is low and myocardial injuries are mostly small. However, recurrent SCAD is common. SCAD is also associated with extra-coronary arteriopathies such as fibromuscular dysplasia (FMD) for which brain-pelvis screening is recommended.
Management after SCAD requires consideration of key issues including menorrhagia, contraception and future pregnancy risk alongside questions around the risk/benefit of exercise and the psychological consequences of SCAD. Clinical trials are needed to provide greater certainty on optimal management.
What is SCAD?
SCAD is a cause of acute coronary syndromes (ACS). It is caused by the generation of a haematoma within the tunica media of the coronary arterial wall (Figure 1) 1
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- Adlam D, Alfonso F, Maas A, Vrints C, Writing C. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018;39(36):3353-3368.
- Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, Ganesh SK, Gulati R, Lindsay ME, Mieres JH, Naderi S, Shah S, Thaler DE, Tweet MS, Wood MJ, American Heart Association Council on Peripheral Vascular D, Council on Clinical C, Council on C, Stroke N, Council on G, Precision M, Stroke C. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation. 2018;137(19):e523-e557.
- Hayes SN, Tweet MS, Adlam D, Kim ESH, Gulati R, Price JE, Rose CH. Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;76(8):961-984.
- Adlam D, Olson TM, Combaret N, Kovacic JC, Iismaa SE, Al-Hussaini A, O’Byrne MM, Bouajila S, Georges A, Mishra K, Braund PS, d’Escamard V, Huang S, Margaritis M, Nelson CP, de Andrade M, Kadian-Dodov D, Welch CA, Mazurkiewicz S, Jeunemaitre X, Consortium D, Wong CMY, Giannoulatou E, Sweeting M, Muller D, Wood A, McGrath-Cadell L, Fatkin D, Dunwoodie SL, Harvey R, Holloway C, Empana JP, Jouven X, Group CADS, Olin JW, Gulati R, Tweet MS, Hayes SN, Samani NJ, Graham RM, Motreff P, Bouatia-Naji N. Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Coronary Artery Dissection. J Am Coll Cardiol. 2019;73(1):58-66.
- Saw J, Starovoytov A, Humphries K, Sheth T, So D, Minhas K, Brass N, Lavoie A, Bishop H, Lavi S, Pearce C, Renner S, Madan M, Welsh RC, Lutchmedial S, Vijayaraghavan R, Aymong E, Har B, Ibrahim R, Gornik HL, Ganesh S, Buller C, Matteau A, Martucci G, Ko D, Mancini GBJ. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. Eur Heart J. 2019;40(15):1188-1197.
- Tweet MS, Young KA, Best PJM, Hyun M, Gulati R, Rose CH, Hayes SN. Association of Pregnancy With Recurrence of Spontaneous Coronary Artery Dissection Among Women With Prior Coronary Artery Dissection. Jama Network Open. 2020;3(9).
- Codsi E, Tweet MS, Rose CH, Arendt KW, Best PJ, Hayes SN. Spontaneous Coronary Artery Dissection in Pregnancy: What Every Obstetrician Should Know. Obstet Gynecol. 2016;128(4):731-8.