Spontaneous coronary artery dissection: A review for clinical and interventional cardiologists
Rev Port Cardiol. 2023 Mar;42(3):269-276.
doi: 10.1016/j.repc.2022.03.008.
Epub 2023 Jan 9.
[Article in
English,
Portuguese]
Affiliations
- 1 Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Department of Pathophysiology and Therapeutic Targets I, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal. Electronic address: brizidocatarina@gmail.com.
- 2 Unidade de Intervenção Cardiovascular (UNICARV), Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
- 3 Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
- 4 Cardiac Intensive Care Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
- 5 Cardiac Intensive Care Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Department of Pathophysiology and Therapeutic Targets I, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
- 6 Unidade de Intervenção Cardiovascular (UNICARV), Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Department of Pathophysiology and Therapeutic Targets I, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
Abstract
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, especially among young to middle-aged women with few traditional cardiovascular risk factors and low pretest probability for atherosclerotic coronary artery disease. Diagnosis by invasive coronary angiography is the gold standard and conservative therapy is generally recommended, with percutaneous or surgical revascularization being reserved for cases of clinical instability, high-risk anatomy or as bailout. Unlike atherothrombotic coronary artery disease, strong evidence on optimal medical therapy is scarce, posing unique challenges in cases of pregnancy-associated SCAD. The follow-up strategy is also of major importance, as recurrent SCAD is not infrequent, lifestyle changes and pharmacological therapy should be planned for the long term, and SCAD-associated conditions need to be addressed. This review aims to provide a practical management approach to SCAD patients for both clinical and interventional cardiologists.
Keywords:
Acute coronary syndrome; Displasia fibromuscular; Dissecção coronária espontânea; Fibromuscular dysplasia; Gravidez; Intervenção coronária percutânea; MINOCA; Minoca; Mulher; Percutaneous coronary intervention; Pregnancy; Spontaneous coronary artery dissection; Síndrome coronária aguda; Woman.
Copyright © 2023 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.
MeSH terms
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Atherosclerosis*
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Cardiologists*
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Coronary Angiography / adverse effects
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Coronary Artery Disease*
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Coronary Vessel Anomalies* / complications
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Female
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Humans
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Middle Aged
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Pregnancy
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Risk Factors
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Vascular Diseases* / diagnosis
Supplementary concepts
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Coronary Artery Dissection, Spontaneous