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, 2, 3
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