Why the study?
Spontaneous coronary artery dissection is an uncommon cause of ACS with potential predisposing factors including coronary vasospasm.
Spasm provocation tests in SCAD patients carry a risk of iatrogenic dissection, suggesting careful timing is needed to avoid high-risk periods.
Raises caution for spasm provocation testing in SCAD; hypothesis-generating for spasm's role in recurrence.
Background: Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS). Various factors predispose individuals to SCAD, including coronary vasospasm, which has been identified in some studies as a related factor. Case summary: recurrence potentially related to coronary spasm, and one case involved iatrogenic coronary artery dissection during a spasm provocation test. Discussion: High recurrence rates of SCAD within 30 days of the initial event have been observed, although the effectiveness of pharmacologic therapy has not been conclusively established. While the administration of beta-blockers has been associated with a reduced risk of SCAD recurrence, their use may not be desirable in patients with coronary vasospasm. Detailed evaluations may be beneficial for patients where coronary vasospasm is suspected to tailor appropriate treatment strategies. Moreover, given the higher frequency of iatrogenic coronary artery dissection among patients with SCAD, careful consideration is needed to avoid high-risk periods when scheduling spasm provocation tests.
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Endo et al. (2024) studied this question.
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