Spontaneous coronary artery dissection: a review of complications and management strategies

ABSTRACT

Introduction: Spontaneous coronary artery dissection (SCAD) accounts for up to 4% of acute coronary syndromes (ACS) on coronary angiography and predominantly affects women (>90%). SCAD most often occurs in patients with few or no conventional cardiovascular risk factors. This condition remains underdiagnosed due to a lack of awareness among health-care providers and misdiagnosis on coronary angiography.

Areas covered: In this review, authors aim to summarize contemporary data on the etiology, morbidity and mortality risks, as well as management strategies in order to raise awareness.

Expert opinion: The last decade of extensive research revealed that SCAD is not as rare as previously thought and needs to be in the differential diagnosis of all MI patients, especially in young to middle-aged women. Predisposing factors, such as fibromuscular dysplasia, and potential triggers like physical or emotional stresses, are frequently linked. Coronary angiography is the first-line diagnostic tool and should be performed meticulously because of more fragile vessel architecture to avoid iatrogenic dissections. If angiographic findings are uncertain, the use of intravascular imaging may be required. Conservative therapy is favored over revascularization unless patients have high-risk features. Recurrent cardiovascular events post-SCAD are frequent, and patients should be closely monitored after a SCAD event.

KEYWORDS:

• Fibromuscular dysplasia
• myocardial infarction
• non-artherosclerotic coronary artery disease
• spontaneous coronary dissection
• women

Declaration of interest

J Saw has received unrestricted research grant supports (from the Canadian Institutes of Health Research, Heart & Stroke Foundation of Canada, National Institutes of Health, University of British Columbia Division of Cardiology, AstraZeneca, Abbott Vascular, St Jude Medical, Boston Scientific, and Servier), speaker honoraria (AstraZeneca, Abbott Vascular, Boston Scientific, and Sunovion), consultancy and advisory board honoraria (AstraZeneca, St Jude Medical, and Abbott Vascular), and proctorship honoraria (Abbott Vascular, St Jude Medical and Boston Scientific). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.