Spontaneous Coronary Artery Dissection: New Insights into This Not-So-Rare Condition

Annu Rev Med. 2022 Jan 27:73:339-354. doi: 10.1146/annurev-med-052819-023826.

Abstract

Spontaneous coronary artery dissection (SCAD) is an uncommon but increasingly recognized cause of acute myocardial infarction (MI) among young and middle-aged women and is an important cause of pregnancy-associated MI. Over 90% of SCAD patients are women. Compared to patients with MI caused by atherosclerosis, SCAD patients have fewer cardiovascular risk factors but more often have systemic arteriopathy, most commonly fibromuscular dysplasia. Angiographically, SCAD is characterized by the presence of an intramural hematoma with or without an intimal tear. Accurate recognition of characteristic findings on coronary angiography is critical, as there are important differences in the acute and long-term management of MI caused by SCAD versus atherosclerosis. Acutely, most SCAD patients should be managed conservatively, since percutaneous revascularization is associated with more complications and SCAD-affected vessels usually heal without intervention. Randomized clinical trials and other prospective evaluations are needed, especially to clarify optimal treatment and prevention strategies.

Keywords: acute myocardial infarction; fibromuscular dysplasia; pregnancy; spontaneous coronary artery dissection; women's health.

Publication types

  • Review

MeSH terms

  • Coronary Angiography / adverse effects
  • Coronary Vessel Anomalies* / diagnostic imaging
  • Coronary Vessel Anomalies* / therapy
  • Female
  • Humans
  • Middle Aged
  • Pregnancy
  • Risk Factors
  • Vascular Diseases* / complications
  • Vascular Diseases* / diagnostic imaging
  • Vascular Diseases* / therapy