Spontaneous Coronary Artery Dissection

Abstract

In general, the long-term outcome of patients with SCAD is excellent, and medical therapy can be safely applied in the majority of patients. However, SCAD can be a life-threatening and sometimes catastrophic event, and some patients experience early or late complications including SCAD of another vessel. © 2015 Wiley Periodicals, Inc.

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

“…SCAD most commonly occurs in patients with few or no traditional cardiovascular risk factors. 8–10,13,16,29 Recent series using careful diagnostic criteria that exclude iatrogenic, traumatic, and atherosclerotic dissection 6 suggest that SCAD may be a cause of up to 1% to 4% of ACS cases overall 8,30–32 (Table 1), occurs overwhelmingly in women, 8,11,13,30,31,33 may be the cause of ACS in up to 35% of MIs in women ≤50 years of age, 11,16,32 and is the most common cause of pregnancy-associated MI (43%) 17 (Table 2). Pregnancy-associated SCAD appears to make up a smaller proportion of overall SCAD than early case series suggest, 13,19,29,33,35 likely as a result of better detection of less severe SCAD among women who were not recently pregnant.…”

“…6,8,11,13,30,31,33,36 One study reported that men presented with SCAD at a slightly younger age than women (mean age, 48.6 [SD, 9.8] years versus 52.3 [SD, 9.2] years; P =0.05). 37,38 Although SCAD has been reported in all major racial and ethnic groups, the majority of patients are white, a finding that may reflect referral and sampling bias and the demography of patients cared for at reporting centers.…”

“…Although any artery can be affected, the left anterior descending artery is the most commonly affected (32%–46% of cases). 8,10,13,16,19,33 In terms of territories, the left anterior descending and diagonal and septal branches are affected in 45% to 61% of cases; the circumflex and ramus and obtuse marginal branches in 15% to 45%; the right coronary artery and acute marginal, posterior descending, and posterolateral branches in 10% to 39%; and the left main artery in up to 4% of cases. 10,11,13,16,19,33 In the majority of cases, the mid to distal segments of coronary arteries are affected; in only <10% of cases are the proximal left anterior descending or circumflex, right coronary, or left main arteries affected.…”

“…69,73 Subsequent cohort studies have shown a varying prevalence of concomitant FMD in extracoronary vascular beds, ranging from 17% to 86%, depending on the patient population, number of imaged vascular beds, and type of imaging used for screening. 6,8,13,29,33,34,74,75 There is also evidence that the prevalence of SCAD is not insignificant in patients with FMD. In the most recent report on dissection and aneurysm in patients with FMD in the US Registry for FMD, of the 237 of 921 patients (25.7%) who experienced ≥1 arterial dissections, 25 patients had SCAD, representing 10.5% of all dissections and an overall prevalence of coronary dissection of 2.7%.…”

“…82 Although FMD is the most common extracoronary vascular abnormality identified among patients with SCAD, patients without imaging signs of FMD have been reported to have other arterial abnormalities, including dissections, aneurysms (including intracranial aneurysms in 14%–23%), or extracoronary and coronary arterial tortuosity (78%). 6,8,13,29,33,74–76,83 Some of these patients may indeed have had FMD but it was not identified because of incomplete or insufficiently sensitive imaging.…”