European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection

TLDR

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes, especially in young to middle‑aged women, with diagnosis rising due to sensitive troponin assays, early angiography, and heightened awareness, and international registries have clarified its distinct pathophysiology and differences in management and outcomes compared to atherosclerotic ACS. This position paper summarizes current knowledge on SCAD to aid clinicians caring for affected patients. It outlines consensus on contemporary SCAD management, highlights remaining controversies, and identifies research priorities.

Abstract

Spontaneous coronary artery dissection (SCAD) has long been recognized as a cause of acute coronary syndromes (ACS). Initially considered very rare and associated primarily with pregnancy and the peripartum period, the use of higher sensitivity Troponin assays and early angiography in ACS, coupled with greater awareness of the condition, has led to increased diagnosis, and it is now understood that SCAD represents a significant cause of ACS in predominantly young to middle-aged women, with most cases occurring outside the context of recent pregnancy.1,2 Although there are no randomized controlled trials in SCAD, knowledge has further advanced in the last 5-years as a result of an international research effort primarily focused on building and studying national SCAD registries.3–19 These studies have demonstrated, not only that SCAD is a distinct pathophysiological entity, but that there are key differences in management and outcomes compared to ACS of atherosclerotic aetiology. This position paper aims to set-out current knowledge on SCAD for the benefit of practicing clinicians caring for patients with this condition. It presents the consensus on contemporary management and areas of controversy and uncertainty, which remain a focus of ongoing research. The information is provided to support clinical care providers but is not intended to replace individualized decision-making by clinicians and other health care professionals.