Spontaneous Coronary Artery Dissection: Report of Two Cases and a 50-Year Review of the Literature

Kamineni, Raghunandan; Sadhu, Ashish; Alpert, Joseph S.

doi:10.1097/00045415-200209000-00004

Cited by 121 publications

(140 citation statements)

References 34 publications

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“…2 Since SCAD may lead to death in the preclinical phase and dissections of the coronary arteries are often difficult to recognise, many authors believe the incidence is underestimated. 3 The mean age at presentation is 35 to 40 years and more than 70% of SCAD cases are women. 4 Classically, the patients are divided into three groups: a peripartum, atherosclerotic and idiopathic group.…”

Section: Discussionmentioning

confidence: 99%

“…3 The clinical presentation of SCAD depends on the extent and severity of the dissection, and ranges from unstable angina to sudden cardiac death. The pathological mechanism leading to this dissection depends on the underlying disease, if present.…”

Section: Idiopathicmentioning

confidence: 99%

“…Dissection of the left anterior descending artery is the most common location in women, whereas right coronary artery dissection is most common in men. 3,4 Recognition of the dissection can be quite difficult and may require multiple angiographic views or IVUS to confirm the diagnosis. 10,11,24 In case 1 we decided not to perform IVUS because on angiography the dissection line in the LAD was clearly visible and there was no doubt about the diagnosis.…”

Section: Idiopathicmentioning

confidence: 99%

“…13 Also men tend to have a better chance of survival compared with women, who have an even worse prognosis when they are not in the peri-or postpartum period. 3,4 In general, it can be stated that the long-term prognosis of patients with SCAD is favourable if they survive the acute phase. 2 Although survival rates and prognosis of patients who present with SCAD vary widely in the literature, data extracted from small series and case reports show survival rates between 70 and 90%.…”

Section: Prognosismentioning

confidence: 99%

“…2 Although survival rates and prognosis of patients who present with SCAD vary widely in the literature, data extracted from small series and case reports show survival rates between 70 and 90%. 3,4 In a review comprising 152 cases over the last 50 years, Kamineni et al reported that 50% of patients with SCAD developed a recurrent dissection within two months. We can confirm these findings because both our patients had a recurrent dissection either in a vertebral artery or a coronary artery within one week after the first event.…”

Section: Prognosismentioning

confidence: 99%

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Spontaneous coronary artery dissection: current insights and therapy

Tanis¹,

Stella²,

Pijlman³

et al. 2008

NHJL

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Spontaneous coronary artery dissection (SCAD) is a very rare cause of acute coronary syndromes in young otherwise healthy patients with a striking predilection for the female gender. The pathological mechanism has not been fully clarified yet. However, several diseases and conditions have been associated with SCAD, such as atherosclerosis, connective tissue disorders and the peripartum episode. In this paper we present a review of the literature, discussing the possible mechanisms for SCAD, therapeutic options and prognosis. The review is illustrated with two SCAD patients who had a recurrence of a spontaneous dissection in another artery within a few days after the initial event. Because of the susceptibility to recurrent spontaneous dissections we propose at least one week of observation in hospital. Further, we will elaborate on the possible conservative and invasive treatment strategies in the acute phase of SCAD. Primary percutaneous coronary intervention remains the reperfusion strategy of choice; however, in small and medium-sized arteries with normalised flow conservative treatment is defendable. In addition, after the acute phase evaluation of possible underlying diseases is necessary, because it affects further treatment. (Neth Heart J 2008;16:344-9.)

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Section: Discussionmentioning

confidence: 99%

Section: Idiopathicmentioning

confidence: 99%

Section: Idiopathicmentioning

confidence: 99%

Section: Prognosismentioning

confidence: 99%

Section: Prognosismentioning

confidence: 99%

See 3 more Smart Citations

Spontaneous coronary artery dissection: current insights and therapy

Tanis¹,

Stella²,

Pijlman³

et al. 2008

NHJL

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Familial Spontaneous Coronary Artery Dissection

et al. 2015

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pontaneous coronary artery dissection (SCAD) is a nonatherosclerotic disease of the coronary arteries and usually presents as acute coronary syndrome. 1,2 The pathogenesis of SCAD involves development of a dissection plane within the coronary artery wall with concurrent intramural hematoma and/or intimal flap, ultimately obstructing flow and causing myocardial ischemia and infarction. Spontaneous coronary artery dissection was previously considered rare, with only individual cases and small case series published. [3][4][5] However, the advent of dedicated online SCAD patient communities and social media communication has led to increased awareness of the condition and robust patient-initiated research activity. More recent studies 6,7 with advanced intracoronary imaging suggest that 1% to 4% of patients with acute coronary syndrome may have SCAD. More importantly, SCAD may be responsible for one-third of the acute coronary syndromes in females younger than 50 years and is the most common cause of peripartum myocardial infarction. [6][7][8][9] The emerging recognition that both the treatment and outcomes of SCAD differ from those of acute coronary syndrome caused by atherosclerosis 1,10,11 highlights the need to increase awareness and diagnostic acumen among health care professionals.Spontaneous coronary artery dissection occurs most commonly in young women with no or minimal cardiovascular risk factors. The exact pathophysiologic mechanisms associated with SCAD are unclear, but associations with the peripartum period, extreme exercise or emotion, connective tissue disorders, and fibromuscular dysplasia have been reported. 1,2,12 Because the estimated 10-year incidence of major adverse cardiovascular events, including death, recurrent SCAD, heart failure, and myocardial infarction after initial SCAD, is high (47%), 1 identification of novel risk factors is critical. To our knowledge, the significance of family history in SCAD has not been previously reported. MethodsThis study was approved by the Mayo Clinic institutional review board. Written informed consent was obtained for participation in the "Virtual" Multicenter Mayo Clinic SCAD Registry, 1,13 which included obtaining medical records from other institutions. We reviewed the medical records of 412 participants with SCAD in the Registry for a history of SCAD or IMPORTANCE Spontaneous coronary artery dissection (SCAD) is a major cause of acute coronary syndrome in young women, especially among those without traditional cardiovascular risk factors. Prior efforts to study SCAD have been hampered by underrecognition and lack of registry-based studies. Risk factors and pathogenesis remain largely undefined, and inheritability has not been reported.OBSERVATIONS Using novel research methods, patient champions, and social media, the Mayo Clinic SCAD Registry has been able to better characterize this condition, which was previously considered rare. Of 412 patient enrollees, we identified 5 familial cases of SCAD comprising affected mother-daughter, identical twin sis...

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