The Spontaneous Coronary Artery Dissection study group of the Association for Acute Cardiovascular Care

In 2016, Spontaneous Coronary Artery Dissection (SCAD) remained an understudied and poorly recognized cause of acute myocardial infarction, predominantly affecting women. The Association for Acute Cardiovascular Care (ACVC) responded to this clear area of patient need by establishing the ESC-ACVC SCAD study group.1 Our vibrant and open study group has benefited from support from patients and colleagues across the ESC family. Together we published the first European Position statement on SCAD in 2019 aiming to provide the first unified advice to clinicians who care for SCAD patients.2 Working together is critical to SCAD research, as only collaboratively can we build enough patient data to progress our understanding of this condition. To investigate the pathophysiology of SCAD, we have undertaken important coronary imaging3 and pathology studies.4 We published the first common risk gene for SCAD PHACTR1 (which interestingly is also a risk variant for fibromuscular dysplasia, migraine, and cervical and intracerebral dissection—all of which occur at increased frequency in SCAD and ischaemic heart disease where the SCAD allele is protective)5 and the first gene sequencing study in this condition.6 We hope to publish the first GWAS later this year. Collaborative work by study group members has begun to reveal potential blood biomarkers which have promise to enhance non-invasive biomarkers of SCAD.7 Colleagues working jointly in SCAD registries across Europe have made important progress in our understanding of the risk factors, diagnosis, and management of this condition.8 This has included demonstrating the important role of emotional stress9 and female sex hormones10 prior to SCAD. We have supported clinicians by advancing recognition of the angiographic features of SCAD11 as well as the potential diagnostic pitfalls.12 From observational data, we have studied the risk-benefit balance for coronary stenting13 and medical therapies such as Aspirin.14 This work has culminated in the first SCAD clinical trial led by Study Group members in Spain.15 We welcome support from colleagues across the ESC family. In particular, after a long build-up, we are finally ready to recruit patients to the ESC-EORP SCAD registry [SCAD Registry (escardio.org)]. This will recruit both retrospective and prospective patients. If your site is not already involved, please do make contact. We need everyone’s help to maximize this opportunity to take another step forward on the road to improving the care and outcomes for patients with SCAD. We also seek to improve support for patients with SCAD by supporting patient organizations such as BeatSCAD (http://beatscad.org.uk) as well as advancing the education of clinical colleagues through the PCR-EAPCI textbook [Percutaneous interventional cardiovascular medicine The PCR-EAPCI Textbook (pcronline.com)]. We are pleased that the first 5 years of our study group have been both an enjoyable partnership and very productive. We thank study group members for their amazing support and hard work and look forward to continuing to welcoming new members, including young members and working together on our registry to make our second 5 years even more exciting than the first! Conflict of interest: Dr Adlam has received research funding from Abbott vascular to support a clinical research fellow. He has also received funding from AstraZeneca inc. for unrelated research and in kind support from the same company for SCAD genetics research. He has undertaken consultancy for General Electric inc. to support research funds.