The Present and Future
JACC State-of-the-Art Review
Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review

https://doi.org/10.1016/j.jacc.2020.05.084Get rights and content
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Highlights

  • SCAD is an important cause of MI, with unique associations and outcomes.

  • Chest pain after SCAD is common; an initial noninvasive approach for stable patients is preferred.

  • Evidence remains sparse for counseling about recurrence risk, physical activity, mental health, and reproductive issues.

  • Prospective and collaborative research across centers and geography are needed to advance the science.

Abstract

Over the past decade, spontaneous coronary artery dissection (SCAD) has emerged as an important cause of myocardial infarction, particularly among younger women. The pace of knowledge acquisition has been rapid, but ongoing challenges include accurately diagnosing SCAD and improving outcomes. Many SCAD patients experience substantial post-SCAD symptoms, recurrent SCAD, and psychosocial distress. Considerable uncertainty remains about optimal management of associated conditions, risk stratification and prevention of complications, recommendations for physical activity, reproductive planning, and the role of genetic evaluations. This review provides a clinical update on the diagnosis and management of patients with SCAD, including pregnancy-associated SCAD and pregnancy after SCAD, and highlight high-priority knowledge gaps that must be addressed.

Key Words

fibromuscular dysplasia
genetics
myocardial infarction
pregnancy-associated
SCAD
women

Abbreviations and Acronyms

AMI
acute myocardial infarction
CTA
computed tomography angiography
EVA
extracoronary vascular abnormality
FMD
fibromuscular dysplasia
IMH
intramural hematoma
PCI
percutaneous intervention
P-SCAD
pregnancy-associated spontaneous coronary artery dissection
OCT
optical coherence tomography
SCAD
spontaneous coronary artery dissection

Cited by (0)

Dr. Kim has served on the Advisory Board for Acer Therapeutics. Dr. Tweet’s work is supported by the Building Interdisciplinary Careers in Women’s Health (BIRCWH) NIH HD 65987. Dr. Adlam has received in-kind research support from AstraZeneca for SCAD genetics research and from Abbott Vascular to support a clinical research fellow involved in SCAD research; has received research funding from AstraZeneca for unrelated research; and has undertaken consultancy with General Electric Inc. to support general research funds. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.

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