Treatment of patients with spontaneous coronary artery dissection: Is there a difference?

Patients with spontaneous coronary artery dissection (SCAD) do not differ from any other acute coronary syndrome (ACS) patients from the first medical contact to coronary angiography; the diagnostic approach and therapy are the same. SCAD patients are identified only based on coronary angiography findings. Perhaps the "SCAD Patient Model" can help. By analyzing registries of SCAD patients, we can see that 90% are women, with 87-95% aged 44-53 years, who may have a personal or family history of fibromuscular dysplasia, and may be correlated with the use of hormone therapy or with changes in hormonal status during pregnancy. Based on this data, we can identify a model of SCAD patient, which is presented by a young woman suggesting a SCAD patient with clinical presentation of ACS. This is almost certain if we have a young pregnant woman or a woman in the postpartum period with ACS. Considering that the use of fibrinolytic therapy in SCAD patients is absolutely contraindicated, and that the diagnosis of SCAD is made only by coronary angiography, it should be considered whether patients with a possible SCAD pattern should not receive fibrinolytic therapy but should be transported to an available PCI center. PCI is indicated in patients with SCAD in cases of TIMI 0 flow on coronary angiography, significant reduction in blood flow in the vessel and persistent chest pain, or hemodynamically unstable patients. The pathophysiological mechanism in SCAD patients is not atherosclerotic disease but an intramural hematoma in the coronary artery wall. Medical treatment of SCAD patients is different from that of patients with an atherosclerotic form of acute coronary syndrome. Dual antiplatelet therapy is administered for a duration of 12 months only in the group of patients undergoing PCI, while others are taking it for a duration of 1 month. Statins, ACE inhibitors are given only to selected patients. It is recommended that beta-blocker therapy be applied to all patients who can tolerate the medication.