Spontaneous coronary artery dissections and associated predisposing factors: a narrative review

Abstract

Spontaneous coronary artery dissection (SCAD) represents around 25% of cases of acute coronary syndromes (ACS) in women aged 40-65 years who have few or no traditional cardiovascular risk factors. It is assumed that the incidence is underestimated, as the angiographic appearance of SCAD may often mimic atherosclerosis. This review aims to examine SCAD by focusing on the associated predisposing factors and precipitating stressors in this heterogeneous patient population, as well as the best treatment approach and the prognosis. Progressive knowledge has improved our current understanding of SCAD, but more awareness among clinicians is necessary. Recently, two position papers from the European Society of Cardiology (ESC) and the American Heart Association (AHA) have been released, which will be summarised in brief.

Keywords: Acute coronary syndrome; Fibromuscular dysplasia; Myocardial infarction; Spontaneous coronary artery dissection; Women.

Fig. 1

Age distribution of patients affected by spontaneous coronary artery dissection (SCAD); the mean age of patients with SCAD was 52.5 ± 9.6 years, 90.5% of SCAD patients were 65 years of age or younger. (From Saw et al. [1])

Fig. 2

Schematic figure of the two proposed mechanisms of spontaneous coronary artery dissection, a Normal artery, b intraluminal haemorrhage, c intimal tear. (From Saw et al. [15])

Fig. 3

Angiographic spontaneous coronary artery dissection classification system proposed by Saw et al. [1]

Fig. 4

Algorithm for the management of an acute spontaneous coronary artery dissection. CABG coronary artery bypass graft, PCI percutaneous coronary intervention. (Adapted from a scientific statement of the American Heart Association [13])