Spontaneous Coronary Artery Dissection: A Review of Epidemiology, Pathophysiology and Principles of Management

Matta, Anthony; Lévai, László; Elbaz, Meyer; Nader, Vanessa; Parada, Francisco Campelo; Carrié, Didier; Roncalli, Jérôme

doi:10.1016/j.cpcardiol.2023.101682

Cited by 15 publications

(32 citation statements)

References 46 publications

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“…This atypical presentation is more common in women, accounts for up to 35% of ACS in women less than 50 years old, and is the most common cause of pregnancy-related myocardial infarction [ 2 , 3 ]. SCAD results from the formation of an intramural hematoma, with or without damage to the endothelium, that causes the development of a false lumen, leading to occlusion and ischemia [ 1 , 2 ]. Underlying vascular conditions are often associated with a diagnosis of SCAD, most commonly fibromuscular dysplasia (FMD).…”

Section: Discussionmentioning

confidence: 99%

A Case of Spontaneous Coronary Artery Dissection

Rougelot,

Pippin

2024

Cureus

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Spontaneous coronary artery dissection (SCAD) is the development of an intramural hematoma that causes a false lumen to form, leading to occlusion and ischemia. It is a rare but separate pathologic cause of acute coronary syndrome, more commonly occurring in females and often associated with underlying vascular conditions. Definitive diagnosis requires invasive coronary angiography. Management is similar to that of myocardial infarction caused by atherosclerosis; however, the majority of SCADs are managed conservatively, as stenting often leads to worse outcomes. Diagnostic and management strategies are primarily based on consensus, with minimal randomized control trials or prospective analyses available to guide patient care.

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Section: Discussionmentioning

confidence: 99%

A Case of Spontaneous Coronary Artery Dissection

Rougelot,

Pippin

2024

Cureus

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“…Progesterone and estrogen have the highest levels during this period, which could be important since the endothelium has the sex hormone receptors. Estrogen induces the release of nitric oxide, resulting in vasodilatation, but it also influences the function of matrix metalloproteinases, which degrades the components of the artery wall and therefore contributes to SCAD (2)(3)(4)(5)(6). SCAD was also reported during lactation when oxytocin is released, which affects vasculature.…”

Section: Female Sex and Pregnancymentioning

confidence: 99%

“…The development of SCAD is explained with two theories. The first theory explains that the formation of intramural hematoma is caused by the tearing of the innermost tunica of the coronary artery, while the second theory is focused on the outer layer and the rupture of its blood vessels, resulting in similar consequences ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…SCAD predominantly affects the left anterior descending artery, in approximately 50% of cases, with the left circumflex and right coronary arteries being affected subsequently. Over 90% of patients experience dissection in the mid and distal segments of epicardial arteries, while 13% of cases involve the left main artery, and approximately 5%–10% of cases affect two or more coronary arteries ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

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A review of the risk and precipitating factors for spontaneous coronary artery dissection

Stanojevic,

Apostolovic,

Kostic

et al. 2023

Front. Cardiovasc. Med.

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IntroductionSpontaneous coronary artery dissection (SCAD) accounts for 1%–4% of cases of acute coronary syndrome (ACS). SCAD is caused by separation occurring within or between any of the three tunics of the coronary artery wall. This leads to intramural hematoma and/or formation of false lumen in the artery, which leads to ischemic changes or infarction of the myocardium. The incidence of SCAD is higher in women than in men, with a ratio of approximately 9:1. It is estimated that SCAD is responsible for 35% of ACS cases in women under the age of 60. The high frequency is particularly observed during pregnancy and in the peripartum period (first week). Traditional risk factors are rare in patients with SCAD, except for hypertension. Patients diagnosed with SCAD have different combinations of risk factors compared with patients who have atherosclerotic changes in their coronary arteries. We presented the most common so-called “non-traditional” risk factors associated with SCAD patients.Risk factors and precipitating disorders which are associated with SCADIn the literature, there are few diseases frequently associated with SCAD, and they are identified as predisposing factors. The predominant cause is fibromuscular dysplasia, followed by inherited connective tissue disorders, systemic inflammatory diseases, pregnancy, use of sex hormones or steroids, use of cocaine or amphetamines, thyroid disorders, migraine, and tinnitus. In recent years, the genetic predisposition for SCAD is also recognized as a predisposing factor. The precipitating factors are also different in women (emotional stress) compared with those in men (physical stress). Women experiencing SCAD frequently describe symptoms of anxiety and depression. These conditions could increase shear stress on the arterial wall and dissection of the coronary artery wall. Despite the advancement of SCAD, we can find significant differences in the clinical presentation between women and men.ConclusionWhen evaluating patients with chest pain or other ACS symptoms who have a low cardiovascular risk, particularly female patients, it is important to consider the possibility of ACS due to SCAD, particularly in conditions often associated with SCAD. This will increase the recognition of SCAD and the timely treatment of affected patients.

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Spontaneous arterial dissection is a rare condition that has been associated with young females, pregnancy, and fibromuscular dysplasia, often occurring without typical cardiovascular risk factors. 1 The association between arterial dissection and autoimmune rheumatic diseases has rarely been described. There have been a few reports of arterial dissections associated with antiphospholipid syndrome (APS), the majority of which involved dissections

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confidence: 99%