Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review

J Am Coll Cardiol. 2020 Aug 25;76(8):961-984. doi: 10.1016/j.jacc.2020.05.084.


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.

Keywords: SCAD; fibromuscular dysplasia; genetics; myocardial infarction; pregnancy-associated; women.

Publication types

  • Review

MeSH terms

  • Coronary Vessel Anomalies* / complications
  • Coronary Vessel Anomalies* / physiopathology
  • Coronary Vessel Anomalies* / psychology
  • Coronary Vessel Anomalies* / therapy
  • Disease Management*
  • Female
  • Humans
  • Myocardial Infarction* / etiology
  • Myocardial Infarction* / prevention & control
  • Pregnancy
  • Pregnancy Complications, Cardiovascular* / etiology
  • Pregnancy Complications, Cardiovascular* / physiopathology
  • Pregnancy Complications, Cardiovascular* / psychology
  • Pregnancy Complications, Cardiovascular* / therapy
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Vascular Diseases / complications
  • Vascular Diseases / congenital*
  • Vascular Diseases / physiopathology
  • Vascular Diseases / psychology
  • Vascular Diseases / therapy

Supplementary concepts

  • Coronary Artery Dissection, Spontaneous