Updates in Spontaneous Coronary Artery Dissection
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MANAGEMENT OF ACUTE CORONARY SYNDROMES (H JNEID, SECTION EDITOR)
Updates in Spontaneous Coronary Artery Dissection Chayakrit Krittanawong 1,2 & Jacqueline Saw 3 & Jeffrey W Olin 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To review the epidemiology, pathogenesis, diagnosis using emerging imaging modalities, management strategy, and prevention of recurrent spontaneous coronary artery dissection (SCAD) and provide a more extensive review of the current data. Recent Findings SCAD generally affects women without conventional cardiovascular risk factors. Diagnosis and management of SCAD are challenging due to heterogeneity, undefined mechanisms, differing phenotypes, and a lack of strong clinical evidence. Summary After reviewing the current evidence to date, we recommend conservative management, including cardiac rehabilitation for SCAD with low-risk features, while coronary revascularization should be considered in SCAD with high-risk features. Non-invasive imaging (e.g., coronary computed tomography angiography, cardiac magnetic resonance, myocardial perfusion imaging) should be considered in diagnosing specific SCAD phenotypes. The standard guideline-based medical therapy for acute coronary syndrome, in the absence of contraindications, should be considered along with appropriate SCAD phenotypes. Discharge counseling and follow-up using emerging imaging modalities should be based on individuals’ profiles and approached on a case by case basis. Keywords Spontaneous coronary artery dissection . SCAD . Recurrent SCAD . SCAD prevention . Cardiac rehabilitation . Coronary revascularization
Introduction Spontaneous coronary artery dissection (SCAD) is an uncommon and heterogenous condition, most commonly This article is part of the Topical Collection on Management of Acute Coronary Syndromes * Chayakrit Krittanawong [email protected] Jacqueline Saw [email protected] Jeffrey W Olin [email protected] 1
Section of Cardiology, Baylor School of Medicine and the Michael E. DeBakey VA Medical Center, 1 Baylor Plaza, Houston, TX 77030, USA
2
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
3
Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
presenting with acute coronary syndrome (ACS). It predominately affects women with few or no conventional cardiovascular risk factors. SCAD is defined as a spontaneous, non-atherosclerotic, non-traumatic, and non-iatrogenic cause of coronary arterial dissection. The diagnosis of SCAD may be challenging, and therefore, many cases of SCAD are not ultimately identified. SCAD can be categorized into low-risk and high-risk subgroups based upon clinical profile, imaging, and angiographic characteristics. SCAD with low-risk features can be managed conservatively, while SCAD with high-risk features, which is associated with worse outcomes including cardiogenic shock, ventricular arrhythmias, or
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