Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome

Nishiguchi, Tsuyoshi; Tanaka, Atsushi; Ozaki, Yuichi; Taruya, Akira; Fukuda, Shota; Taguchi, Haruyuki; Iwaguro, Tetsuya; Ueno, S.; Okumoto, Yasushi; Akasaka, Takashi

doi:10.1177/2048872613504310

Cited by 278 publications

(183 citation statements)

References 30 publications

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“…3 Moreover, SCAD has been found to be a factor in up to 40% of heart attacks in women under the age of 50 years. 4 About half of SCADs initially present as ST-segment-elevation myocardial infarction, and one quarter present with multivessel involvement.…”

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confidence: 99%

Spontaneous Coronary Artery Dissection (SCAD): New Insights into This Not-So-Rare Condition

Hayes¹

2014

Texas Heart Institute Journal

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Spontaneous coronary artery dissection (SCAD) is an uncommon and poorly understood cause of acute coronary syndrome (ACS), myocardial infarction, and sudden cardiac death.1 Spontaneous coronary artery dissection is a sudden separation between the layers of a coronary artery wall that creates an intimal flap or intramural hematoma, obstructing blood flow (Fig. 1A) The true prevalence, causes, prognosis, recurrence rate, and optimal management of SCAD remain uncertain, but recent increases in the use of social media, in patient engagement, and in the formation of disease-specific online communities have facilitated case finding and have accelerated the progress of SCAD research.2 Advances in imaging techniques and better recognition of acute SCAD have led to several new insights and have generated interest in this underrecognized and understudied condition.The demographics, causes, and natural history of ACS associated with SCAD are distinct from those of ACS caused by atherosclerosis or plaque rupture. Spontaneous coronary artery dissection patients are typically young women who do not have risk factors for atherosclerosis. The average age of incident SCAD is 42 years, with reported cases from the age of 14 years to well into the 7th decade. Approximately 80% of SCAD patients are female and, of those, 20% to 25% of cases occur in the peripartum period.In recent accounts of series that have used careful angiographic evaluation or advanced intracoronary imaging to detect intramural hematoma and more subtle dissections, the true prevalence of SCAD (a phenomenon once believed rare) has been reported to be as high as 1% to 4% of ACS overall.3 Moreover, SCAD has been found to be a factor in up to 40% of heart attacks in women under the age of 50 years.4 About half of SCADs initially present as ST-segment-elevation myocardial infarction, and one quarter present with multivessel involvement. 1 Diagnosis and ManagementThe diagnosis of SCAD requires careful angiographic study and a high degree of suspicion. Accurate differentiation of ACS due to SCAD from ACS due to atherosclerosis is crucial, because the approaches to both acute and long-term management are different. Intravascular ultrasonography and optical coherence tomography can be invaluable adjuncts to inadequate or nondiagnostic angiographic imaging. Advanced imaging in the acute setting should be strongly considered in individuals who do not have standard coronary heart disease risk factors, in young or postpartum women, or in patients who show an absence of plaque in noninfarct-related coronary arteries.The most important reasons for accurately diagnosing SCAD are that patients undergoing percutaneous coronary intervention (PCI) for acute SCAD have technical success rates that are markedly reduced (Fig. 1B) compared with PCI success rates for atherosclerotic ACS (62% vs 92%) 1,5 ; and the substantial rate of spontaneous vascular healing 1,6 suggests a role for conservative management in stable SCAD patients who have preserved coronary flow.5 Although conservativ...

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confidence: 99%

Spontaneous Coronary Artery Dissection (SCAD): New Insights into This Not-So-Rare Condition

Hayes¹

2014

Texas Heart Institute Journal

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“…A better awareness of the disease and the improvement of coronary diagnostic imaging has over time led to an increased number of diagnoses. In the coronary angiography era SCAD prevalence has risen from 0.2% to 1.1% [3,4] to 1.7% to 4% according to more recent reports [5,6]. The prevalent occurrence of SCAD in women has also been well documented: Vanzetto reported a 8.7% prevalence of SCAD in women younger than 50 years in a series of more than 10000 acute coronary syndrome (ACS) patients [7].…”

Section: Epidemiologymentioning

confidence: 89%

How to Approach a Spontaneous Coronary Artery Dissection: An Up-To-Date

Pepe¹,

Cecere²,

Napodano³

et al. 2017

Interv Cardiol J

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AbstarctSpontaneous coronary artery dissection (SCAD) is a separation of the coronary wall layers, not related to trauma, medical procedures or atherosclerosis. The dissection causes the blood entry in the vascular wall with the consequent formation of a false lumen and intramural hematoma (IMH). Two pathogenetic mechanisms have been proposed to explain SCAD: a "primary" rupture of coronary endothelium or the rupture of the "vasa vasorum". Clinical presentation and severity of manifestations are variable, ranging from complete absence of symptoms to acute coronary syndrome (ACS), cardiogenic shock, cardiac arrest or sudden cardiac death. Despite coronary angiography is the first-line examination, by supplying two-dimensional images of the lumen, it does not always allow an incontrovertible diagnosis of SCAD. New intravascular imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS), have been recently introduced and may be extremely helpful in assessing the coronary wall integrity, thus improving coronary angiography diagnostic accuracy.Because of the lack of large randomized trials comparing different strategies, the optimal treatment of SCAD is still controversial. The first-line approach is conservative and based on medical therapy. Nevertheless, in particular situations an invasive approach is necessary. In the last years, several new strategies have improved the way to perform percutaneous coronary interventions (PCI), such as new generation drug eluting stents (DES), bio-resorbable scaffolds (BRS), sirolimus self-expandable stent (SES), drug eluting balloons (DEB), and cutting balloon. Cardiac artery bypass graft (CABG) is an even more invasive method to restore coronary flow and should be considered in urgent/emergent settings when PCI is not feasible or has failed.Cause the therapeutic approach of SCAD can be substantially different from that of atherosclerotic coronary artery disease, an accurate diagnosis is crucial to set up the best treatment strategy.

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“…It was thought to be a rare cause of ACS with a prevalence of 0.2–1.1% based on coronary angiographic findings. However, a recent contemporary review suspect that the true prevalence in patients presenting with ACS might be as high as 1.7–4% on the basis of moderate series [4,5]. SCAD affects women in more than 90% of the cases, and with the exclusion of the atherosclerotic cases, women constitute up to 95% of the cases [4,6–8].…”

Section: Discussionmentioning

confidence: 99%

A case of spontaneous coronary artery dissection presenting with acute anterior wall myocardial infarction in a young adult male – an increasingly recognized rare disease

Taha

Latt

Al‐Khafaji

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Background: Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction and sudden death. Although some correlations have been noted in relation to aetiology, no direct causes have been identified in a large number of patients. Most of the patients are women in peripartum period or of childbearing age, with few if any risk factors for coronary heart disease. In men, however, risk factors for atherosclerosis are more prevalent in cases of SCADCase report: We report a case of a 43-years-old healthy male, with no known risk factors, who presented with ischemic chest pain and elevated troponin levels. He underwent an emergent percutaneous transluminal coronary angiography which revealed a total occlusion of the left anterior descending artery at its origin with an evidence of spontaneous dissection as the cause of the occlusion, which was subsequently treated with placement of a drug-eluting stent and thrombectomy from the distal occluded portion. This case highlights the importance of including spontaneous coronary artery dissection as a cause of ischemic cardiac insults and illustrates the approach to treatment.Conclusion: Internists should have a low threshold of clinical suspicion for SCAD especially in a young patient with no known risk factors and should know the importance of emergency in management.

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Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome

Abstract: SCAD is not a rare cause for ACS, especially in females without classical coronary risk factors.

Cited by 278 publications

References 30 publications

Spontaneous Coronary Artery Dissection (SCAD): New Insights into This Not-So-Rare Condition

Spontaneous Coronary Artery Dissection (SCAD): New Insights into This Not-So-Rare Condition

How to Approach a Spontaneous Coronary Artery Dissection: An Up-To-Date

A case of spontaneous coronary artery dissection presenting with acute anterior wall myocardial infarction in a young adult male – an increasingly recognized rare disease

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