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World J Cardiol. Oct 26, 2022; 14(10): 522-536
Published online Oct 26, 2022. doi: 10.4330/wjc.v14.i10.522
Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies
Nikolaos Lionakis, Alexandros Briasoulis, Virginia Zouganeli, Stavros Dimopoulos, Dionisios Kalpakos, Christos Kourek
Nikolaos Lionakis, Dionisios Kalpakos, Christos Kourek, Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
Alexandros Briasoulis, Department of Clinical Therapeutics, Alexandra Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
Alexandros Briasoulis, Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa Hospitals and Clinics, IA 52242, United States
Virginia Zouganeli, Second Cardiology Department, Attikon University Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 12462, Greece
Stavros Dimopoulos, Christos Kourek, Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Department of Critical Care Medicine, Evangelismos Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 10676, Greece
Stavros Dimopoulos, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
Author contributions: Kourek C performed the majority of the writing and prepared the figures; Lionakis N, Briasoulis A, Zouganeli V and Dimopoulos S provided the input in writing the paper; Lionakis N, Kourek C and Kalpakos D designed the outline and coordinated the writing of the paper; all authors revised and approved the final draft. Lionakis N and Kourek C contributed equally to this work.
Conflict-of-interest statement: All authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stavros Dimopoulos, MD, PhD, Director, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Sygrou Avenue Kallithea GR, Athens 17674, Greece. stdimop@gmail.com
Received: August 10, 2022
Peer-review started: August 10, 2022
First decision: September 5, 2022
Revised: September 14, 2022
Accepted: October 5, 2022
Article in press: October 5, 2022
Published online: October 26, 2022
Processing time: 70 Days and 11.8 Hours
Abstract

Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors. SCAD is frequently linked with predisposing factors, such as postpartum, fibromuscular dysplasia or other vasculopathies, connective tissue disease and hormonal therapy, and it is often triggered by intense physical or emotional stress, sympathomimetic drugs, childbirth and activities increasing shear stress of the coronary artery walls. Patients with SCAD usually present at the emergency department with chest discomfort, chest pain, and rapid heartbeat or fluttery. During the last decades, the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis. However, modern imaging techniques such as optical coherence tomography, intravascular ultrasound, coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease. Treatment of SCAD remains controversial, especially during the last years, where invasive techniques are being used more often and in more emergent cardiac syndromes. Although conservative treatment combining aspirin and beta-blocker remains the recommended strategy in most cases, revascularization could also be suggested as a method of treatment in specific indications, but with a higher risk of complications. The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients. Follow-up should be performed on a regular basis.

Keywords: Spontaneous coronary artery dissection; Non-atherosclerotic coronary artery disease; Angiographic classification; Percutaneous coronary intervention

Core Tip: Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. During the last decades, the most common problem in SCAD was the lack of awareness of the disease which led to significant underdiagnosis and misdiagnosis. However, modern imaging techniques such as optical coherence tomography, intravascular ultrasound, coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of SCAD. Although conservative treatment combining aspirin and beta-blocker remains the recommended strategy in most cases, revascularization could also be suggested as a method of treatment in specific indications.