https://orcid.org/0000-0003-2342-9224
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ABSTRACT
Though an infrequent cause of acute coronary syndrome, spontaneous coronary artery dissection is an increasingly recognized cardiovascular condition predominantly seen in middle-aged females. Its pathophysiology is defined by separation of coronary arterial wall layers which cause acute coronary syndrome-like presentations with relatively high recurrence rates. Overall, there is a lack of reported literature and understanding of the short- and long-term management for spontaneous coronary artery dissection. Therapeutic approaches include, but are not limited to, percutaneous coronary intervention, surgical revascularization, antithrombotic therapy, and beta-blocker therapy. There is a significant absence of randomized control trials to help guide both interventional and medical management for spontaneous coronary artery dissection. This review is aimed to review the current literature regarding risk factors and considerations for the short- and long-term management of spontaneous coronary artery dissection.
Plain Language Summary
Spontaneous coronary artery dissection is a condition commonly found in middle-aged females with symptoms that mimic a traditional ‘heart-attack.’ The condition differs where it is without actual arterial blood clot formation within the coronary arteries. In general, spontaneous coronary artery dissection involves the tearing of certain layers within coronary artery walls causing the expansion of layers with bleeding in between, consequently causing arterial blockage. In general, there is a lack of consensus on therapeutic strategy for this condition given a limited amount of data. This review article expands on the current data regarding the management of spontaneous coronary artery dissection including interventional versus medical management. Despite being rare, this acute disease process can have significant implications; however, it has been found that a more conservative approach with close monitoring is generally recommended.
Abbreviations
| SCAD | = | spontaneous coronary artery dissection |
| IMH | = | intramural hemorrhage |
| CAD | = | coronary artery disease |
| ACS | = | acute coronary syndrome |
| FMD | = | fibromuscular dysplasia |
| STEMI | = | ST-elevation myocardial infarction |
| IVUS | = | intravascular ultrasound |
| OCT | = | optical coherence tomography |
| CTA | = | computerized tomography angiography |
| TIMI | = | thrombolysis in myocardial infarction |
| DAPT | = | dual antiplatelet therapy |
| MACE | = | major adverse cardiovascular events |
| PCI | = | percutaneous coronary intervention |
| MCS | = | mechanical circulatory support |
| CABG | = | coronary artery bypass grafting |
Declaration of financial/other relationships
The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
Haris Patail: Review of literature, conceptualization, writing, and editing. Tanya Sharma: Review of literature, conceptualization, writing, and editing. Wilbert Aronow: Review of literature and editing. Syed Abbas Haidry: Review of literature, writing, and editing.