Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Circulation. 2018 May 8;137(19):e523-e557. doi: 10.1161/CIR.0000000000000564. Epub 2018 Feb 22.


Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.

Keywords: AHA Scientific Statements; coronary artery dissection, spontaneous; fibromuscular dysplasia; myocardial infarction; women.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • American Heart Association*
  • Cardiac Imaging Techniques / standards
  • Cardiovascular Agents / therapeutic use
  • Consensus
  • Conservative Treatment / standards
  • Coronary Artery Bypass / standards
  • Coronary Vessel Anomalies* / diagnostic imaging
  • Coronary Vessel Anomalies* / mortality
  • Coronary Vessel Anomalies* / therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / standards
  • Predictive Value of Tests
  • Pregnancy
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome
  • United States
  • Vascular Diseases / congenital*
  • Vascular Diseases / diagnostic imaging
  • Vascular Diseases / mortality
  • Vascular Diseases / therapy


  • Cardiovascular Agents

Supplementary concepts

  • Coronary Artery Dissection, Spontaneous