The diagnosis and management of spontaneous coronary artery dissection — expert opinion of the Association of Cardiovascular Interventions (ACVI) of Polish Cardiac Society

Spontaneous coronary artery dissection (SCAD) has been recognized as a relatively uncommon disease for several years. The condition, although described, was poorly characterized in the era before intravascular imaging. As a result, women with SCAD were often misdiagnosed with an atheromatous acute coronary syndrome (ACS), MINOCA, or takotsubo cardiomyopathy. Increasing numbers of recent studies, including large registries, confirm that it should no longer be called a “rare” disease. These studies provided new information about the incidence, pathophysiological concepts, methods of diagnosis, and the treatment of this condition [1–9]. This paper aims to increase the awareness of SCAD among clinicians who take care of patients with acute coronary syndromes in the emergency room, through the catheterization laboratory, cardiology wards, to general practitioners. We present the recommendations regarding the identification of SCAD on angiography, the indications for the use of intravascular imaging, the methods of acute treatment, and long-term post-SCAD management. As prospective randomized trials are not available, these recommendations are based on retrospective analyses of series of patients or reflect experts’ consensus.