The Present and Future
State-of-the-Art Review
Contemporary Review on Spontaneous Coronary Artery Dissection

https://doi.org/10.1016/j.jacc.2016.05.034Get rights and content
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Abstract

Spontaneous coronary artery dissection (SCAD) is gaining recognition as an important cause of myocardial infarction, especially in young women. There has been a surge in the diagnosis of SCAD in recent years, presumably due to an increased use of coronary angiography, and the clinical availability and application of high-resolution intracoronary imaging. The improved recognition and diagnosis, together with increased publications and attention through social media, have considerably raised awareness of this condition, which was once believed to be very rare. Recent publications of moderate to large contemporary case series have helped elucidate the early natural history, presenting characteristics (clinical and angiographic), underlying etiology, management, and cardiovascular outcomes with this condition, thus providing observations and important clinical insights of value to clinicians managing this challenging and perplexing patient cohort. The aim of our review is to provide a comprehensive contemporary update of SCAD to aid health care professionals in managing these patients in both the acute and chronic settings.

Key Words

fibromuscular dysplasia
myocardial infarction
women

Abbreviations and Acronyms

ACS
acute coronary syndrome
CABG
coronary artery bypass graft
CTA
computed tomography angiography
DAPT
dual antiplatelet therapy
FMD
fibromuscular dysplasia
IMH
intramural hematoma
IVUS
intravascular ultrasound
MACE
major adverse cardiac events
MI
myocardial infarction
MRA
magnetic resonance angiography
OCT
optical coherence tomography
PCI
percutaneous coronary intervention
SCAD
spontaneous coronary artery dissection
STEMI
ST-segment elevation myocardial infarction
TIMI
Thrombolysis In Myocardial Infarction

Cited by (0)

Dr. Saw has received research grants and speaker honoraria from AstraZeneca; has received research grants and speaker honoraria and been a consultant, a member of the advisory board, and a proctor for Boston Scientific and St. Jude Medical; has received speaker honoraria from Sunovion; has been a member of the advisory board for Abbott Vascular; and has received research grants from Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.