Why the study?
There are currently no randomized controlled trials comparing different management strategies for spontaneous coronary artery dissection, leaving practice based on case observations, registries, and extrapolated guidelines.
This case series highlights that spontaneous coronary artery dissection should be considered in young patients presenting with ACS, and supports conservative management in hemodynamically stable patients.
Conservative management may suffice in stable SCAD; leaves open RCTs comparing revascularization strategies.
Spontaneous coronary artery dissection (SCAD) is an acute coronary event related to the development of a hematoma in the media, leading to separation of the intima or intima-media complex from the underlying vessel, thus compressing the true lumen, causing ischemia and myocardial infarction. It usually occurs in middle-aged women with few or no cardiovascular risk factors. Coronary angiography can make the diagnosis in most cases, and endocoronary imaging is reserved for ambiguous cases. There is currently no randomized controlled trial comparing the different management strategies for spontaneous coronary dissections (conservative approach, coronary revascularization strategies including percutaneous coronary intervention and coronary artery bypass grafting). Current practice is therefore based on case observations and registries on clinical experience and on extrapolation (when applicable) of guidelines for the treatment of acute coronary syndrome.
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Bouraghda et al. (2023) studied this question.
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