Materiały źródłowe

• #1 Spontaneous coronary artery dissection epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Spontaneous_coronary_artery_dissection_epidemiology_and_demographics

  The annual incidence of spontaneous coronary artery dissection is estimated at 0.26 per 100,000 persons (0.33 in women and 0.18 in men), corresponding to approximately 800 new cases per year in the United States. […] The true prevalence of spontaneous coronary artery dissection in the general population remains unknown; however, retrospective angiographic registries have reported a SCAD detection rate of 0.1 to 1.1% among all coronary angiograms performed. […] The case fatality rate of SCAD is relatively low compared with other causes of ACS, with an estimated in-hospital mortality rate of 0 to 4%. […] The average age at diagnosis of SCAD in females ranges from 44 to 53 years, although patients may present with SCAD in their second through ninth decades of life. […] SCAD has a strong predilection for young women with no or minimal traditional cardiovascular risk factors.

• #2 Epidemiology and Pathophysiology of Spontaneous Coronary Artery Dissection | Encyclopedia MDPI

  https://encyclopedia.pub/entry/history/compare_revision/88755

  Spontaneous Coronary Artery Dissection (SCAD) refers to the spontaneous separation of the layers of the vessel wall caused by intramural hemorrhage, with or without an intimal tear. This condition is not associated with trauma, atherosclerosis or iatrogenic causes and may be an expression of an underlying systemic arterial disease, namely, fibromuscular dysplasia. […] The real incidence of spontaneous coronary artery dissection (SCAD) is difficult to define as it is often underestimated. Although SCAD is an uncommon cause of all heart attacks (<1% of all acute myocardial infarctions are caused by spontaneous dissections), its incidence in acute myocardial infarctions in women remains considerable. It is estimated that about 1/3 of acute myocardial infarctions in women <50 years are caused by spontaneous dissections.

• #3 Spontaneous coronary artery dissection – UpToDate

  https://www.uptodate.com/contents/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) is a nontraumatic, noniatrogenic separation of the coronary arterial wall and is an infrequent cause of acute myocardial infarction. […] It is more common in younger patients and in women. […] In a Danish study, annual SCAD incidence was 0.7 among patients referred for angiogram and 0.2 among patients with acute coronary syndrome (ACS). […] In the general population, SCAD is the cause of ACS in 0.1 to 4 percent of cases.

• #4 Spontaneous coronary artery dissection

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes (ACS). More cases are now being identified due to increased awareness and earlier use of invasive angiography in patients presenting with acute chest pain. […] SCAD is estimated to be responsible for 0.1% to 0.4% of all ACS cases. It is an important cause of ACS in young women, responsible for up to 25% of all ACS cases in women 50 years of age. […] The Mayo Clinic registry of 87 consecutive patients with SCAD reported a mean age of 43 years; 82% were female. No cause was identified in 45% of all cases, highlighting that many cases of SCAD remain unexplained. […] The commonest identified predisposing factors were postpartum, fibromuscular dysplasia (FMD), connective tissue disease and hormonal therapy. Potential stressors include extreme physical exertion, particularly in young male patients, intense emotional stress, sympathomimetic drugs (such as cocaine, amphetamines), childbirth and Valsalva-like activities (such as coughing, retching, vomiting). […] Triggers for SCAD are thought to increase shear stress on the coronary artery wall, often mediated by elevated catecholamine levels and intra-abdominal pressure.

• #5 Spontaneous Coronary Artery Dissection: Clinical Considerations in Diagnosis and Treatment – American College of Cardiology

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/20/11/41/Spontaneous-Coronary-Artery-Dissection

  Spontaneous coronary artery dissection (SCAD) is a unique clinical entity and an important cause of myocardial infarction (MI), particularly among young and middle-aged women. SCAD is defined as a non-iatrogenic, non-traumatic separation of the coronary artery wall, not associated with atherosclerosis. The original studies implicated SCAD as the cause of acute coronary syndrome in 0.1% to 4% of cases, but more recent studies have shown SCAD to be the underlying cause of MI in 22-43% of women <50 years. [...] Early and accurate diagnosis of SCAD is vital because the management strategy employed in this condition significantly differs from that of atherosclerotic disease. [...] A paucity of data exists regarding optimal management of SCAD due to lack of randomized trials comparing medical therapy and revascularization strategies.

• #6 Spontaneous coronary artery dissection—A review – Yip – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/5668/html

  Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome (ACS). […] SCAD can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. […] It is difficult to ascertain the true prevalence of SCAD as it is often under-diagnosed and have varying presentations from mild chest pains to sudden cardiac death. […] In patients presenting with ACS, SCAD is noted to occur in 3-4%, diagnosed with optical coherence tomography (OCT). […] Among women presenting with ACS, the prevalence was reported to be higher at 8.7% among those 50 years old. […] At our center, upon thorough angiographic review, we found the prevalence of SCAD to be much higher at 24% in women 50 years of age who had a myocardial infarction (MI).

• #7 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Spontaneous-Coronary-Artery-Dissection-(SCAD).aspx

  Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic, nontraumatic separation of the coronary arterial walls and causes acute coronary syndrome and sudden cardiac death. […] The overwhelming majority of patients are women, between 87 and 95% of SCAD patients, and are typically between the ages of 44 and 53. […] Studies have demonstrated difficulty ascertaining the true prevalence of SCAD; this condition is often underdiagnosed, with variability in its presentations observed. […] Most of these cases were misdiagnosed, highlighting the challenges and underdiagnosis of SCAD.

• #8 Epidemiology and Pathophysiology of Spontaneous Coronary Artery Dissection | Encyclopedia MDPI

  https://encyclopedia.pub/entry/history/compare_revision/88755

  The “typical” SCAD patient is a middle-aged woman with few traditional cardiovascular risk factors, albeit acute coronary syndrome (ACS) due to SCAD has been observed from the late teens to the ninth decade of life. […] SCAD is likely influenced by a combination of factors that include sex; hormonal fluctuations; underlying arteriopathies; genetics; and environmental, physical, and emotional precipitants. […] Women comprise 87% to 95% of SCAD with a mean age of presentation between 44 and 53 years. […] Data on SCAD in men are limited because the prevalence of this condition among men is low. SCAD in men is more frequently associated with excessive physical exertion (e.g., exercise or heavy lifting) and tends to have a lower prevalence of fibromuscular dysplasia than in women with SCAD.

• #9 Spontaneous coronary artery dissection—A review – Yip – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/5668/html

  The etiology of FMD is unknown, however, hormonal influences had been proposed and a small proportion may be genetically inherited. […] The conventional teaching is that SCAD occurred predominantly in young women. However, in our recent series, the average age was 52.19.2 years, and 58% were actually age 50 years or older. […] Thus, SCAD does not exclusively affect young women. […] The early case reports and series on SCAD had relied on post-mortem diagnosis. Current widespread availability of coronary angiography enabled earlier diagnosis of SCAD. […] The natural history of SCAD appears to entail spontaneous healing in the vast majority of cases. […] The decision to revascularize the dissected artery depends on the patients clinical status and affected coronary anatomy. […] In our cohort, 80% were treated conservatively with good outcomes, with 4.8% recurrent MI in-hospital and 0% mortality.

• #10 Spontaneous coronary artery dissection

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes (ACS). More cases are now being identified due to increased awareness and earlier use of invasive angiography in patients presenting with acute chest pain. […] SCAD is estimated to be responsible for 0.1% to 0.4% of all ACS cases. It is an important cause of ACS in young women, responsible for up to 25% of all ACS cases in women 50 years of age. […] The Mayo Clinic registry of 87 consecutive patients with SCAD reported a mean age of 43 years; 82% were female. No cause was identified in 45% of all cases, highlighting that many cases of SCAD remain unexplained. […] The commonest identified predisposing factors were postpartum, fibromuscular dysplasia (FMD), connective tissue disease and hormonal therapy. Potential stressors include extreme physical exertion, particularly in young male patients, intense emotional stress, sympathomimetic drugs (such as cocaine, amphetamines), childbirth and Valsalva-like activities (such as coughing, retching, vomiting). […] Triggers for SCAD are thought to increase shear stress on the coronary artery wall, often mediated by elevated catecholamine levels and intra-abdominal pressure.

• #11 Spontaneous coronary artery dissection epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Spontaneous_coronary_artery_dissection_epidemiology_and_demographics

  The prevalence of SCAD reported by retrospective angiographic registries ranges from 0.2 to 2.0% among all ACS cases and from 8.7 to 35.0% among women 50 years with ACS. […] The prevalence of SCAD decreases with age, and is estimated at 7.6%, 4.0%, 2.1%, and 1.2% in women below the age of 40, 50, 60, and 70, respectively. […] SCAD has been reported in all major racial and ethnic groups, with the majority of patients being white.

• #12 Sex Differences in Spontaneous Coronary Artery Dissection | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-cardiovascular-disease-review-spontaneous-coronary-artery?language_content_entity=en

  This review highlights sex- and gender-specific considerations in cardiovascular diseases with a particular focus on pathophysiology, epidemiology, clinical presentation, risk factors, diagnosis, and management of spontaneous coronary artery dissection. […] SCAD has been described in individuals ranging in age from 18 to 84 years, largely debunking the notion that it is primarily a disease of the young. […] SCAD is believed to be the etiology of MI in 24-35% of women below the age of 60 years. […] Recent analysis of the Canadian SCAD cohort suggests that men with SCAD tend to be younger, with a mean age of 49.4 ± 9.6 years in men versus 52.0 ± 10.6 years in women. […] A study using data from the National Readmission Database assessed adult hospitalizations involving a primary diagnosis of SCAD and found that men were more likely than women to have atherosclerotic risk factors, including prior history of diabetes, hypertension, hyperlipidemia, and chronic kidney disease.

• #13 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Spontaneous coronary artery dissection can affect both sexes, but the incidence is overwhelmingly higher in women in their fifth and sixth decades of life (about 90%) than in men. The risk factors for atherosclerotic coronary artery disease risk are lower in these patients than those who have ACS due to plaque rupture. SCAD is a rare cause of acute coronary syndrome overall and constitutes only 1% of all myocardial infarctions. As the condition is rare in men, data is limited for men. […] The known risk factors are pregnancy, postpartum state, concomitant FMD, arteriolopathies, and physical and emotional stressors. The majority of patients affected are white women. Mortality is low, about 1-2%, and the incidence of recurrent ACS is about 18%.

• #14 Sex Differences in Spontaneous Coronary Artery Dissection | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-cardiovascular-disease-review-spontaneous-coronary-artery?language_content_entity=en

  SCAD events have been shown to occur just before or during menstruation in premenopausal females, corresponding to the luteal phase of the menstrual cycle, and shortly after pregnancy in postpartum females. […] Given the unpredictable nature of SCAD and the minimal value of cardiovascular testing as surveillance to predict recurrence and increased severity of presentation associated with pregnancy, patients must undergo detailed preconception counseling to avoid unplanned pregnancies. […] SCAD is often the first symptom of an underlying vascular disease. […] The prevalence of FMD in patients with SCAD ranges from 45% to 72%, with recent literature suggesting a prevalence greater than 50%. […] In a 3-year follow-up of a Canadian SCAD cohort, fewer men had FMD than women (27.8% versus 52.7%) overall. […] The rate of in-hospital adverse events in this population was rare and similar between men and women. […] There is ongoing research regarding optimal medical management for SCAD.

• #15 Spontaneous coronary artery dissection—A review – Yip – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/5668/html

  The majority of these cases were mis-diagnosed, highlighting the challenge and clear under-diagnosis of SCAD. […] SCAD has been observed in women who are peripartum or with multiple prior pregnancies, and thus a significant association with pregnancy has been postulated. […] Although early retrospective studies suggested that as high as 30% of SCAD cases were peripartum, more recent series showed much lower proportion of SCAD related to the peripartum state. […] In our series of 168 patients, pregnancy-related SCAD accounted for only 2.4% of cases. […] In patients with underlying predisposing arteriopathies, there can often be precipitating stressors such as intense exercise or emotional stress, which may trigger the SCAD event. […] Our group has discovered a strong association between SCAD and FMD, a condition that also predominantly affects women.

• #16 Sex Differences in Spontaneous Coronary Artery Dissection | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-cardiovascular-disease-review-spontaneous-coronary-artery?language_content_entity=en

  Other studies suggest that cardiovascular risk profiles are similar between men and women with SCAD. […] The cause of SCAD is multifactorial with genetic factors, hormones, and arteriopathies playing a role, as well as environmental or emotional stressors precipitating the event. […] SCAD is the most common etiology of MI in pregnant patients, often presenting more severely and with a higher prevalence of ST-elevation MI (STEMI) than SCAD in patients who are not pregnant. […] Pregnancy-associated SCAD (p-SCAD) accounts for approximately 5-10% of all SCAD cases, with most events occurring in the third trimester and the early postpartum period. […] The prevalence of SCAD during pregnancy and the 6-week postpartum period is 1.81 events per 100,000 pregnancies in a US administrative database.

• #17 Epidemiology and Pathophysiology of Spontaneous Coronary Artery Dissection | Encyclopedia MDPI

  https://encyclopedia.pub/entry/history/compare_revision/88755

  SCAD fatalities are uncommon; however, their incidence remains unknown, due to challenges with accurate post-mortem diagnosis. […] Pregnancy-associated SCAD (P-SCAD; usually defined as SCAD occurring during gestation or within 12 months of delivery) accounts for approximately 5–10% of cases of SCAD. […] Reportedly accounts for 10–22% of ACS events in pregnancy and 23–67% of postpartum ACS. […] There is growing evidence that P-SCAD is associated with a more severe phenotype with proximal and extensive dissections and larger infarcts. […] SCAD occurs rarely in patients with known hereditary conditions. Familial SCAD is rare, and pathogenic variants were identified in only 3.5% of unselected patients in a genome sequencing study, suggesting that most cases are sporadic; therefore, at present, testing genetic is not recommended in all cases of SCAD.

• #18 Epidemiology and Pathophysiology of Spontaneous Coronary Artery Dissection | Encyclopedia MDPI

  https://encyclopedia.pub/entry/history/compare_revision/88755

  Although the prevalence of classic risk factors for ischemic disease is low, coronary dissection is more frequently associated with arterial hypertension and less frequently with diabetes mellitus. […] The left anterior descending coronary artery is involved in about 40% of SCAD, mainly in its mid-to-distal segments. Other vessels or multivessel SCADs are less common.

• #19 Outcomes of patients with spontaneous coronary artery dissection | Open Heart

  https://openheart.bmj.com/content/3/2/e000491

  Spontaneous coronary artery dissection (SCAD) is an uncommon but serious condition presenting as an acute coronary syndrome (ACS) or cardiac arrest. The pathophysiology and outcomes are poorly understood. We investigated the characteristics and outcomes of patients presenting with SCAD. […] In a retrospective study of a large cohort of patients with SCAD, data were collected regarding clinical presentation, patient characteristics, vascular screening, coronary artery involvement and clinical outcomes. […] 40 patients with SCAD (95% women, mean age 4510years) were included. At least 1 traditional cardiovascular risk factor was present in 40% of patients. Migraine was reported in 43% of patients. […] The left anterior descending artery was most frequently involved (68% of patients), and 13% had involvement of multiple coronary territories.

• #20 Spontaneous Coronary Artery Dissection: A Review of Epidemiology, Pathophysiology and Principles of Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36893966/

  Spontaneous coronary artery dissection (SCAD) is a sudden rupture of coronary artery wall leading to false lumen and intramural hematoma formation. It commonly occurs in young and middle-aged women lacking typical cardiovascular risk factors. Fibromuscular dysplasia and pregnancy are strongly associated with SCAD. […] The overall prognosis of patients with SCAD is favorable marked by a spontaneous healing in a large proportion of cases.

• #21 Spontaneous coronary artery dissection—A review – Yip – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/5668/html

  The success rate with PCI for SCAD is poor compared with atherosclerotic lesions, and long-term durability with PCI was only ~30% in our cohort. […] The initial mortality rates appeared to be over-estimated due mainly to post-mortem reporting and little ante-mortem data. […] More recent studies reported lower in-hospital mortality rates ranging from 1% to 5%. […] The long-term outcome of patients who survived their initial SCAD presentation is good; however, recurrent events are frequent and these patients should be followed closely by cardiovascular specialists.

• #22 Outcomes of patients with spontaneous coronary artery dissection | Open Heart

  https://openheart.bmj.com/content/3/2/e000491

  Over a median 16-month follow-up period, 8% of patients had at least 1 recurrent SCAD event. There were no deaths. […] Patients with SCAD in this study often had multiple coronary territories involved (13%) and extracardiac vascular abnormalities, suggesting a systemic vascular process, which may explain the high incidence of migraine. […] All patients with SCAD should be screened for FMD and followed closely due to the possibility of recurrence. […] Spontaneous coronary artery dissection (SCAD) tends to occur in younger female patients and has a strong association with extracoronary fibromuscular dysplasia. A recent association has also been reported between SCAD and migraine. […] Our study strengthens the association between spontaneous coronary artery dissection (SCAD) and migraine, which was strictly defined using the International Headache Society criteria.

• #23 Spontaneous coronary artery dissection: Principles of management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/11/623

  In a retrospective study of 189 patients with SCAD, the procedural failure rate was 53% in those managed with PCI. […] The recurrent SCAD rate was 10.4% over a median follow-up of 3.1 years. […] Patients should therefore be monitored closely for new or worsening cardiac symptoms, which should prompt further testing. […] Chronic management of SCAD is based on several key principles, ie, screening for fibro-muscular dysplasia, monitoring for chest pain and recurrence, and cardiac rehabilitation. […] Cardiac rehabilitation is an important component of management following SCAD, but it remains significantly underused.

• #24 Spontaneous Coronary Artery Dissection (SCAD) – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/spontaneous-coronary-artery-dissection-scad/

  Average age ranges from 45 to 53 years of age (Hayes 2018). […] Clear female to male predominance is seen in SCAD. […] High rates of intermediate, long term, and 10-year major adverse cardiac events and recurrent MI (Hayes 2018). […] Identification of poor prognostic factors or risk factors is difficult due to small sample sizes of studies (see overview graphic). […] Severe anatomical coronary tortuosity has been identified as the only risk factor for recurrence (Hayes 2018).

• #25 Clinical outcomes by angiographic type of spontaneous coronary artery dissection | EuroIntervention

  https://eurointervention.pcronline.com/article/clinical-outcomes-by-angiographic-type-of-spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) is an increasingly diagnosed cause of myocardial infarction. […] The aim of this study was to evaluate the relationship between an angiographic classification and the development of adverse clinical events during the follow-up of a large, unselected cohort of patients with SCAD. […] The SCAD angiographic classification correlates with outcome. Those presenting with an angiographically circumscribed contained intramural haematoma (angiotypes 2A and 3) showed an increased risk of short-term adverse clinical events that was maintained during follow-up. […] SCAD is increasingly recognised as an important cause of acute coronary syndrome among young and middle-aged women. […] The use of an angiographic classification of SCAD discriminated patients with different rates of events. Patients with SCAD presenting with an angiographically circumscribed and contained haematoma (angiotypes 2A and 3) showed an increased risk of adverse clinical events during admission that was maintained during long-term follow-up.

• #26 Advances in the Management of Spontaneous Coronary Artery Dissection (SCAD): A Comprehensive Review

  https://www.imrpress.com/journal/RCM/25/9/10.31083/j.rcm2509345/htm

  The predominant female population, precipitating factors, clinical presentation, restitutio ad integrum and significant recurrence risk are also shared with other singular conditions such as Tako-Tsubo Syndrome (TTS). […] In particular, as TTS typically occurs after a relevant emotional trigger such as SCAD, cases of concomitant SCAD and TTS presentation are reported in the literature and may further lead to SCAD underdiagnosis as macroscopic features of TTS are often more easily recognizable. […] Different study groups have reported an increased risk of reinfarction and unscheduled percutaneous coronary intervention (PCI) in SCAD types 2a and 3. […] This association appears to be related to the presence of an intramural hematoma that has not evolved with the creation of a dissecting flap: therefore, these two subtypes are potentially more unstable and correlated with higher event rates during follow-up.

• #27 Outcomes of patients with spontaneous coronary artery dissection | Open Heart

  https://openheart.bmj.com/content/3/2/e000491

  Our cohort prevalence of FMD of 18% represents a significantly higher proportion than previously reported in the population, at 3%. […] Screening systematically for FMD in patients presenting with SCAD remains important for prognostication. […] At follow-up, 8% of our patients had at least one new coronary dissection. An additional 8% of patients had another coronary vascular event at follow-up. Patients with SCAD therefore require close outpatient surveillance.

• #28 Outcomes of patients with spontaneous coronary artery dissection | Open Heart

  https://openheart.bmj.com/content/3/2/e000491

  There should be systematic screening of renal and carotid arteries in patients presenting with spontaneous coronary artery dissection, and patients should be followed up closely in the outpatient setting to monitor for recurrent coronary events. […] The pathogenesis of SCAD remains incompletely understood. […] The lack of trial data on SCAD makes its management challenging. […] We therefore aimed to investigate, in patients presenting with SCAD, the associated medical issues and the clinical outcomes. […] Multiple coronary territory involvement, the frequent finding of extracardiac vascular disease and association with migraine suggest that SCAD is part of a systemic vascular disease process and not merely a localised weakness in the wall of a single coronary artery. […] SCAD also occurs not infrequently in the peri-partum period, and in association with hormonal fluxes.

• #29 Spontaneous Coronary Artery Dissection: Clinical Considerations in Diagnosis and Treatment – American College of Cardiology

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/20/11/41/Spontaneous-Coronary-Artery-Dissection

  CanSCAD (the Canadian SCAD Cohort Study), the largest multicenter prospective observational SCAD study, enrolled 750 patients with SCAD from 22 North American centers from 2014 to 2018. […] SCAD is an enigmatic disease, and our understanding of the disease has progressed in recent years, largely owing to several registries including CanSCAD.

• #30 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  In a systematic review of n=4206 patients with SCAD, beta-blockers were found to be significantly associated with a reduced risk of SCAD recurrence after adjustment for confounders. […] The prevalence of FMD among patients with SCAD was variable between studies. […] FMD screening has been advocated for in all patients with SCAD. […] The role of antiplatelet therapy in SCAD has been controversial. […] There are currently no randomised controlled trial data to guide treatment of SCAD. […] The currently enrolling BA-SCAD trial will be the first to provide important data about the efficacy and safety of beta-blockers and anti-platelet therapy in patients with SCAD.

• #31 Spontaneous coronary artery dissection: from expert consensus statements to evidence-based medicine – Alfonso – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/22447/html

  Screening for associated conditions has been incorporated as part of the diagnostic work-up in SCAD patients. […] An early invasive strategy is indicated for most patients with ACS. However, in contradistinction to patients with ACAD, a conservative management rather than revascularization is suggested for patients with SCAD. […] Observational data suggest that prognosis is favorable when patients with SCAD are managed conservatively. […] Management of pregnancy-related SCAD is particularly challenging. […] Current evidence suggests low referral of these patients to rehabilitation programs despite emerging evidence supporting its benefits in this particular setting. […] The AHA scientific statement on SCAD clearly highlights major research areas and key questions regarding: (I) epidemiology, (II) pathogenesis, (III) diagnosis and (IV) treatment. […] Major efforts are required to spur collaboration research in order to allow advances in the diagnostic and management of this disease.

• #32 Spontaneous Coronary Artery Dissection Current State of the Science – Professional Heart Daily | American Heart Association

  https://professional.heart.org/en/science-news/spontaneous-coronary-artery-dissection-current-state-of-the-science

  Spontaneous Coronary Artery Dissection (SCAD) is an important cause of Myocardial Infarction, especially in young women, but its prevalence is uncertain because it’s underdiagnosed. A lack of familiarity with the condition contributes to it being missed in young women even in the presence of classic symptoms. Limitations of current coronary angiographic techniques exacerbate this problem. […] This statement identifies research priorities in epidemiology, etiology, diagnosis, and treatment and poses key questions to spur collaboration.

• #33 Spontaneous coronary artery dissection: from expert consensus statements to evidence-based medicine – Alfonso – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/22447/html

  Spontaneous coronary artery dissection (SCAD) represents an increasingly recognized cause of acute coronary syndrome (ACS), especially in young females. […] Heightened awareness and novel diagnostic tools, especially intracoronary imaging, suggest that SCAD is much more prevalent than previously thought. […] Importantly, SCAD may constitute the underlying etiology of myocardial infarction in up to one-third of women aged 50 years. […] The association with systemic arteriopathies and FMD in particular (2085% of cases) has been well-established. […] The term pregnancy-associated SCAD rather than peripartum SCAD, is currently preferred. […] Prevalence has been reported as 1.8 SCAD events every 100,000 pregnancies. […] Despite increasing awareness, SCAD continues to be underdiagnosed or misdiagnosed as ACAD.

• #34 Spontaneous coronary artery dissection – Wikipedia

  https://en.wikipedia.org/wiki/Spontaneous_coronary_artery_dissection

  SCAD is the most common cause of heart attacks in pregnant and postpartum women. Over 90% of people who develop SCAD are women. […] It is especially common among women aged 43-52. […] With angiography and improved recognition of the condition, diagnosis of SCAD has improved since the early 2010s. While prior studies had reported a SCAD prevalence of less than 1% in patients presenting with acute coronary syndrome, more recent data suggests the prevalence of SCAD in acute coronary syndrome patients may be between 2-4%.

• #35 Epidemiology, management, outcomes and pathophysiology of SCAD – Health Research Authority

  https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/epidemiology-management-outcomes-and-pathophysiology-of-scad/

  Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction with an increased incidence in young women, particularly in the peri and post-partum period. […] To date research into this condition in the UK and internationally has been very limited. […] Our project, which has strong support from national cardiovascular societies and patients, will establish a long-term portal for the on-going recruitment and follow-up of SCAD patients.

• #36 Genome-wide association meta-analysis of spontaneous coronary artery dissection identifies risk variants and genes related to artery integrity and tissue-mediated coagulation | Nature Genetics

  https://www.nature.com/articles/s41588-023-01410-1

  Spontaneous coronary artery dissection (SCAD) is an understudied cause of myocardial infarction primarily affecting women. […] Here we present a genome-wide association meta-analysis (1,917 cases and 9,292 controls) identifying 16 risk loci for SCAD. […] Several associated variants have diametrically opposite associations with CAD, suggesting that shared biological processes contribute to both diseases, but through different mechanisms. […] Our findings provide novel pathophysiological insights involving arterial integrity and tissue-mediated coagulation in SCAD and set the stage for future specific therapeutics and preventions. […] The search for highly penetrant mutations in candidate pathways or by sequencing has garnered a low yield, often pointing to genes involved in other clinically undiagnosed inherited syndromes manifesting as SCAD.

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