Key result
Conservative management is the recommended primary strategy for spontaneous coronary artery dissection, as percutaneous coronary intervention carries high periprocedural complication rates up to 22%.
Why the study?
SCAD is an increasingly recognized cause of ACS, particularly in women under 50 years of age, but evidence-based management data remain scarce.
This review emphasizes that conservative management is the preferred strategy for stable SCAD, while PCI should be strictly reserved for patients with hemodynamic instability or ongoing ischemia due to high rates of technical failure and iatrogenic complications.
PURPOSE OF REVIEW: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS), particularly among women < 50 years of age. Here, we aim to review the pathogenesis of SCAD, discuss SCAD as an initial manifestation of systemic arterial disease, and highlight invasive strategies as well as unique challenges in the care of women with SCAD. RECENT FINDINGS: A paradigm shift has occurred in the care of SCAD patients in the past decade as recommendations for conservative management have become widespread. Invasive interventions are reserved for patients with hemodynamic compromise or active ischemia due to increased periprocedural complications and failure rates. Certain patient populations have been identified for larger territory infarcts and proximal disease including patients with known connective tissue disease, premenopausal women, and patients with pregnancy-associated SCAD (P-SCAD). Current recommended management of SCAD is conservative. Despite a growing awareness of SCAD and its known association with systemic arteriopathies in women, evidence-based data remains scarce. Future studies focused on identifying genetic factors, optimal medical therapy after SCAD, and techniques to minimize interventional complications are needed.
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Brunton et al. (2024) conducted a review in Spontaneous Coronary Artery Dissection (SCAD). Conservative management is the recommended primary strategy for spontaneous coronary artery dissection, as percutaneous coronary intervention carries high periprocedural complication rates up to 22%.
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