Spontaneous Coronary Artery Dissection

Abstract

In our large prospectively followed SCAD cohort, long-term cardiovascular events were common. Hypertension increased the risk of recurrent SCAD, whereas beta-blocker therapy appeared to be protective.

Spontaneous coronary artery dissection in women: What is known and what is yet to be understood

“…3,5–8,12,13 Classic modifiable risk factors for atherosclerosis are not common among SCAD patients. In 2 recent series with >300 SCAD patients each, diabetes mellitus was present in only 0.9% to 4.6%, smoking in 0.6% to 10%, hypertension in 27% to 36%, and mean body mass index was 24 kg/m 2 5,12 . Although SCAD has been reported in virtually every race and ethnicity and in most world geographical regions, most reported SCAD patients in contemporary series and registries are white women.…”

“…This may be related to selection bias, access to healthcare and research, pathophysiology of SCAD, or other unknown factors. 5,12 …”

“…3,5–8,12 Although SCAD patients may present with chest pain and other ischemic symptoms, the initial electrocardiogram and troponin levels may be normal; thus, serial evaluations are advised in those with concerning symptoms. 14 Some patients with history of SCAD report stuttering chest pain or a possible inciting trigger in the days prior to their ACS, suggesting that the SCAD may evolve before causing clinically urgent myocardial injury.…”

“…9 In 9% to 18% of cases, SCAD is present in >1 coronary artery at presentation, which is referred to as multivessel SCAD. 3,5–8,12 …”

“…For instance, as many as 12% to 48% of patients report extreme exertion or intense stress/emotion prior to their SCAD ACS. 5,12 Examples include swimming in cold lakes, downhill skiing, recent unemployment, or death of a close relative/friend. Although the association of SCAD with extreme exertion has been reported more commonly among men, 3,19 this association is also observed among women.…”