Spontaneous Coronary Artery Dissection: Latest Developments and New Frontiers

AbstractPurpose of ReviewSpontaneous coronary artery dissection (SCAD) is an increasingly recognized entity leading to myocardial infarction especially in women. Multiple observational studies have been published in the recent years. This review summarizes the current body of knowledge and recent developments in SCAD epidemiology, presentation, diagnosis, and management.Recent FindingsContemporary series have estimated the incidence of SCAD to be up to ~  4% of all patients presenting with acute coronary syndrome (ACS). Fibromuscular dysplasia, hormonal therapy, multiparity, connective tissue disorders, and systemic inflammatory diseases have been identified as predisposing factors for SCAD. Although SCAD typically presents as ACS, emerging eviden ce shows that cardiogenic shock, ventricular arrhythmia, and cardiac arrest are not uncommon, with higher incidence of complication among peripartum women. Advances in SCAD diagnosis include a novel angiographic classification of SCAD and the use of optical coherence tomography and intravascular ult rasound to aid in diagnosis. Management depends on clinical stability and the presence of high-risk features. Beta-blockers are the mainstay of medical therapy long term and was shown to reduce recurrent SCAD. The largest study to date including 750 patients across 22 North American centers showed t hat the majority of patients was managed conservatively and that the technical success rates of percutaneous coronary intervention were lo...
Source: Current Atherosclerosis Reports - Category: Cardiology Source Type: research