Materiały źródłowe

• #1 Mayo Clinic Health Library – Spontaneous coronary artery dissection (SCAD) | Swiss Medical Network

  https://www.swissmedical.net/it/healtcare-library/con-20188640

  The goals of SCAD treatment are to: […] Treatment may include medicines and a procedure or surgery to open the artery and restore blood flow. Sometimes SCAD heals on its own. […] The type of treatment for SCAD depends on your overall health and the size and location of the tear in the artery. […] Some people with SCAD only need medicines to treat symptoms. If chest pain or other symptoms continue, other treatments also might be needed. […] Medicines to treat SCAD may include: […] Taking aspirin long-term may help to lower the risk of heart disease after SCAD. […] Several medicines are available to lower blood pressure. You might need to take these medicines for life to reduce the risk of another SCAD. […] Medicines called nitrates and calcium channel blockers can help treat chest pain after SCAD.

• #1 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. […] A paucity of data exists regarding optimal management of SCAD due to lack of randomized trials comparing medical therapy and revascularization strategies. Observational data have shown that when repeat angiography is performed, 70-97% of conservatively managed patients displayed angiographic healing of SCAD lesions. As such, a conservative treatment strategy is recommended in most cases, which includes an extended inpatient monitoring period of 3-5 days. The backbone of long-term medical therapy in SCAD is a combination of aspirin and beta-blocker. Beta-blocker use has been associated with a lower risk of recurrent SCAD (hazard ratio 0.36) and is therefore an essential part of long-term therapy at our institution.

• #1 Drugs for spontaneous coronary dissection: a few untrusted options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10667692/

  Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome that is often overlooked, misdiagnosed, and maltreated. Medical treatment poses a significant challenge because of the lack of randomized studies to guide treatment. The initial clinical presentation should guide medical and interventional management. Fibrinolytic agents and anticoagulants should be avoided because they could favor hematoma propagation. In patients with SCAD, antiplatelet therapy should be prescribed especially dual antiplatelet therapy (DAPT) consisting of aspirin and clopidogrel, whereas potent P2Y12 inhibitors, e.g., ticagrelor and prasugrel, should be avoided. If a stent was used, DAPT should be continued for 12 months. Aspirin only can be an option for patients without high-risk angiographic features thrombus burden, critical stenosis, and decreased coronary flow. Beta-blocking (BB) agents should be used to prevent recurrence of SCAD. There is a general agreement that angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, mineralocorticoid antagonists, and loop diuretics should be used in patients with SCAD experiencing the symptoms of heart failure and a decrease in left ventricular ejection fraction below 50%. Although without firm evidence, statins can be used in SCAD due to their pleiotropic properties. The results of a randomized trial on the use of BB and statins are awaited. Aggregation of data from national registries might point out truly beneficial medications for patients with SCAD.

• #1 Spontaneous Coronary Artery Dissection (SCAD) – Victor Chang Cardiac Research Institute

  https://www.victorchang.edu.au/heart-disease/scad

  The Institute has submitted a grant application as the Australian contingent of the first international randomised, controlled trial of SCAD management (the APT-SCAD trial) involving over 2,500 SCAD survivors from 190 centres in 10 countries. This trial will test if moderate – as compared to intensive, blood-thinning treatment improves outcomes and reduces major adverse cardiovascular events, including bleeding and recurrences, in SCAD patients. […] If successful, the Institute will be the coordinator of the Australian arm of this study, which will involve 200 SCAD patients.

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

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

  The role of antiplatelet therapy in SCAD has been controversial. […] Antiplatelet use may therefore be beneficial in reducing this thrombus burden. […] In their scientific statements, the AHA and ESC suggested at least a single antiplatelet agent (aspirin), to be used acutely. […] However, even single antiplatelet therapy can create problems in younger female patients, with menorrhagia a frequent adverse event. […] The use of anticoagulation in the acute phase carries the same considerations as discussed in the antiplatelets section above. […] 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; RR of 0.51 (95% CI 0.33 -0.77, P=0.0013). […] Beta-blockers have therefore been recommended in all patients with SCAD.

• #1 Drugs for spontaneous coronary dissection: a few untrusted options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10667692/

  In patients presenting with ACS, the currently recommended medical treatment consists of dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 receptor inhibitor. However, this therapy could cause harm in patients with SCAD, unless this included stent implantation. Based on the pathophysiology of the disease, medical treatment should aim for the preservation of flow in the affected artery and cessation of hematoma propagation, which may be conflicting goals to achieve. Fibrinolytic therapy has been shown to extend the dissection and worsen prognosis in these patients. […] The use of BBs in SCAD should be guided by measuring the potential benefits of their use against the risks and contraindications. In addition, one should bear in mind that SCAD patients are usually BB nave and that treatment should be carefully tailored and monitored throughout the hospital stay.

• #1 Drugs for spontaneous coronary dissection: a few untrusted options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10667692/

  There is a general agreement that angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARB), mineralocorticoid antagonists, and loop diuretics should be used in patients with SCAD experiencing the symptoms of heart failure with rise in natriuretic peptides and decrease in LVEF below 50%. The use of heart failure therapy in SCAD patients with normal LVEF cannot be justified. […] Despite the prevailing opinion that SCAD patients do not have traditional atherosclerotic risk factors, including dyslipidemia, the data from the large registries demonstrate that these patients can often suffer from this disorder. The DISCO registry revealed that 37.2% of patients had dyslipidemia prior to the SCAD event. […] Antiplatelet agents should be prescribed in patients with SCAD, especially DAPT consisting of aspirin and clopidogrel and limited to 1 month based on the high incidence of recurrence of intimal tear in this period after the initial event. In patients presenting with large thrombus burden, after balloon angioplasty with non-compliant or cutting balloon, it seems reasonable to prescribe DAPT consisting of aspirin and clopidogrel also for 1 month. However, in patients without high-risk features such as concomitant atherosclerosis, large thrombus burden, critical stenosis that was left untreated, and significant flow impairment in affected coronary arteries, it would be prudent to prescribe SAPT consisting of only aspirin. If the affected vessel was treated with stent implantation, DAPT should be prescribed according to the guidelines for up to 12 months after the event. The potent P2Y12 inhibitors such as ticagrelor or prasugrel should be avoided because the potential benefits of powerful platelet inhibition would be offset by the risk of hematoma propagation. […] The use of BBs in SCAD should be guided by measuring the potential benefits of their use against the risks and contraindications.

• #1 Management of SCAD | Spontaneous Coronary Artery Dissection (SCAD)

  https://scad.ubc.ca/management-of-scad/

  A percentage of SCAD events involve intimal tears that are prothrombotic and would likely benefit from antiplatelet therapy. Therefore, we typically administer aspirin and clopidogrel for acute SCAD patients and follow-up with clopidogrel for 1 year and aspirin for life. […] Anticoagulation treatment for SCAD is controversial. While there is a risk of extending dissections this is balanced by the potential to resolve overlying thrombus and improve true lumen patency. […] Medical management of SCAD deviates from standard ACS therapy. In particular, thrombolytic therapy should be avoided for patients with SCAD. […] Beta-blockers offer benefits in aortic dissection by reducing arterial wall shear stress. Extrapolating these benefits, we routinely administer beta-blockers for SCAD, both acutely and long-term.

• #1 Management of SCAD | Spontaneous Coronary Artery Dissection (SCAD)

  https://scad.ubc.ca/management-of-scad/

  The choice to revascularize a dissected artery depends on both the affected coronary anatomy and the patients clinical status. Conservative treatment is preferred for most stable patients without ongoing pain. However, patients with ongoing chest pain, ischemia, ST elevation, or hemodynamic instability should undergo PCI, especially when the dissection affects major arteries with sizable myocardial jeopardy. […] Emergency CABG should be considered for patients where the dissection involves the left main. […] Stenting may not be practical where the dissected artery segment is distal, of small calibre, or when the dissection is extensive. […] Lastly, the natural history of the dissected segments is such that the vast majority heals spontaneously, and patients appear to have good long-term outcome if they survive their initial event. We recommend reserving PCI for patients with ongoing chest pain and ischemia when the lesion is amenable to stenting, and to consider CABG for extensive dissections involving the left main. […] If PCI is attempted, there are strategies that may improve outcome. […] There is no consensus as to repeat imaging after SCAD, irrespective of revascularization strategies.

• #1 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

  Revascularization for SCAD should be considered in patients exhibiting active myocardial ischemia, hemodynamic instability, or left main dissection, in whom conservative management is an unsatisfactory alternative. Coronary artery bypass grafting surgery (CABG) should be reserved for patients with left main or multivessel proximal large-vessel dissection, especially in the setting of hemodynamic compromise. […] According to observational studies, percutaneous coronary intervention (PCI) for treatment of SCAD is associated with lower success rates and higher rates of complications compared with PCI for atherosclerotic CAD. In SCAD, affected coronary arteries are more susceptible to iatrogenic dissections. […] There are several proposed strategies aimed at improving the success rate of PCI in SCAD. For diffuse long lesions, a multi-stent approach may be used to first seal the distal and proximal ends of dissections before stenting the middle segment in order to prevent and minimize IMH propagation. […] Advances in diagnostic and therapeutic PCI techniques in the near future may also prove beneficial in treatment of patients with SCAD.

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

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

  Despite these often poor outcomes, revascularization procedures may be appropriate in patients with the following high-risk features: left main coronary artery dissection, ongoing ischemia, thrombolysis in Myocardial Infarction (TIMI) grade 01 flow in a proximal vessel, hemodynamic instability, and refractory arrhythmia. […] For SCAD complicated by cardiogenic shock, mechanical circulatory support may be considered in accordance with consensus guidelines for non-SCAD ACS treatment. […] While case reports suggest that an intraaortic balloon pump and extracorporeal membrane oxygenation can be used safely in patients with SCAD, they should be used with caution because, given the high incidence of concomitant arteriopathies in patients with SCAD, insertion of large-bore arterial catheters can theoretically result in iatrogenic dissection of the iliac arteries or aorta.

• #1 Spontaneous Coronary Artery Dissection: Current State

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/03/02/11/28/Spontaneous-Coronary-Artery-Dissection-Current-State

  SCAD is thought to be caused by either an intimal tear, which allows blood to enter and generate a false lumen, or a spontaneous hemorrhage arising from the vasa vasorum within the vessel wall. In several cases, the intimal rupture site was not identified. […] The diagnosis of SCAD must not be missed. Some patients are discharged prematurely based on their young age and lack of cardiovascular risk factors. […] Conservative management should be considered in clinically stable patients without high-risk anatomy. Extended inpatient monitoring for 3-5 days is recommended. In patients with ongoing ischemia, left main artery dissection, or hemodynamic instability, urgent intervention with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) can be considered. […] PCI for treatment of SCAD is associated with an increased risk of complications and technical failure. The risk of iatrogenic dissections and extension of dissections can be reduced by avoiding deep catheter engagement, noncoaxial positioning of catheter tip, catheter dampening, and strong contrast agent injection.

• #1 Mayo Clinic Health Library – Spontaneous coronary artery dissection (SCAD) | Swiss Medical Network

  https://www.swissmedical.net/it/healtcare-library/con-20188640

  Some people with SCAD need a surgery or procedure to fix the artery and improve blood flow to the heart. […] This treatment may be needed if SCAD blocks blood flow to the heart or medicines don’t control chest pain. […] During the procedure, a doctor places a long, thin flexible tube called a catheter in a blood vessel, usually in the groin or wrist. […] This open-heart surgery creates a new path for blood to flow around a blocked or partially blocked artery. […] If you’ve had SCAD, talk to a health care professional before becoming pregnant. […] After treatment for SCAD, you need regular checkups with your health care team. […] A personalized program of exercise and education may be suggested. This is called cardiac rehabilitation, also known as cardiac rehab. It’s created to help you recover from a serious heart condition.

• #1 Spontaneous Coronary Artery Dissection (SCAD) – Victor Chang Cardiac Research Institute

  https://www.victorchang.edu.au/heart-disease/scad

  The goal of treatment for spontaneous coronary artery dissection (SCAD) is to restore blood flow to the heart. Treatment plans will depend on the severity of your condition including the size and location of the tear. Treatments may include: […] Inserting a stent to hold the artery open […] Surgery to bypass the damaged artery […] Medications such as aspirin, blood-thinning drugs, blood pressure drugs or medications to control chest pain, cholesterol drugs, beta blockers […] Checking and monitoring weaknesses in other blood vessels […] Cardiac rehabilitation programs. […] Ideally, cardiac rehabilitation for a SCAD should be started a few weeks after leaving hospital. Don’t worry if you or the patient has been out of hospital for longer than this, one should still go to cardiac rehab to get benefits. When deciding on a start date, the cardiac rehab staff will consider your heart condition and medical history. Fortunately, SCADs all heal within 30-35 days, but light rehab can be started before this. Be sure to inform the rehab staff that you’ve had a SCAD heart attack and not a traditional one, as the rehab program needs to be modified accordingly.

• #1 Spontaneous coronary artery dissection

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

  Patients with left main stem involvement, complete vessel occlusion, ongoing chest pain or haemodynamic instability will require coronary revascularisation. PCI results are suboptimal in this challenging group of patients. […] Although long-term prognosis is excellent, the risk of recurrent SCAD events is significant, with an average rate of 5% per year.

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

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

  FMD screening has been advocated for in all patients with SCAD. […] The prevalence of FMD has been reported to be as high as 86%. […] It is recommended that all patients with SCAD following an ACS should be referred to cardiac rehabilitation. […] Current cardiac rehabilitation programs usually cater for older patients with atherosclerotic MI, and may be less suitable for younger patients with SCAD. […] SCAD-specific cardiac rehabilitation programs have been reported with encouraging results and should be used if available.

• #1 Spontaneous Coronary Artery Dissection (SCAD) | Treatment & Diagnosis | UH Harrington Heart & Vascular Institute | University Hospitals | Cleveland, Ohio | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/spontaneous-coronary-artery-dissection

  Bypass Surgery: In some cases, open-heart coronary artery bypass surgery may be need to restore adequate blood flow to the heart. In this procedure, the surgeon forms a new path for blood to reach the heart, thereby bypassing the damaged artery. To accomplish this, the surgeon removes part of a healthy blood vessel from the patient’s leg, arm or chest and connects it below and above the blocked arteries in the heart. Patient’s need several weeks to recover from open-heart surgery. […] If you are treated for SCAD, you’ll require follow-up appointments with your doctor to monitor for any changes in your condition, including the development of any new tears in your arteries. Your doctor may also recommend other types of care to help you recover and to prevent other health problems. Continuing care measures may include: Cardiac Rehabilitation: Cardiac rehabilitation is a tailored program of education and exercise designed to help you recover from a serious heart condition. The program typically includes monitored exercise, nutritional counseling, education and emotional support. Genetic Testing: For some patients, genetic testing may be recommended to screen for genetic mutations associated with vascular connective tissue disorders such as Loeys-Deitz syndrome, Marfan syndrome and vascular Ehlers-Danlos syndrome. Check Other Blood Vessels for Abnormalities: For many patients, the doctor will recommend imaging studies of the blood vessels outside of the chest to look for aneurysms, other dissections, and signs of the underlying condition fibromuscular dysplasia (FMD).

• #1 Spontaneous Coronary Artery Dissection: Current State

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/03/02/11/28/Spontaneous-Coronary-Artery-Dissection-Current-State

  CABG is appropriate for left main and proximal dissections, PCI complications, or ongoing ischemia. […] Systemic anticoagulation with heparin should be avoided after the diagnosis of SCAD. Dual antiplatelet therapy is recommended after PCI. In patients managed medically, most experts recommend aspirin for at least a year, and some also recommend clopidogrel for a few months to a year. […] Cardiac rehabilitation is important for SCAD survivors. Severe restrictions in activity and weight lifting are not necessary, but extreme high-intensity exercise should be avoided.

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

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

  Currently no randomised trial data is available to guide management. […] The Beta-blockers and Antiplatelet agents in patients with Spontaneous Coronary Artery Dissection (BA-SCAD) trial is currently enrolling and will address this important and unresolved knowledge gap. […] Post-SCAD chest pain is a common issue affecting more than half of SCAD survivors. […] Anti-anginal medications, such as nitrates or calcium channel blockers could be considered to treat chronic post SCAD chest pain. […] SCAD is one of the most common causes of MI in pregnant women with the post-partum period the most at-risk period. […] Pregnancy-related SCAD (P-SCAD) usually has higher incidences of ST elevation myocardial infarction, reduced left ventricular ejection fraction, involvement of the left main artery or multivessel SCAD.

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

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

  Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome (ACS) in young females without any known cardiovascular risk factors. […] Diagnosis is confirmed primarily by cardiac catheterization and coronary angiogram; intravascular imaging can be done if a coronary angiogram is inconclusive. […] General and interventional cardiologists, advanced cardiovascular imaging specialists, and cardiac surgeons should be on board for the management. […] Conservative management is usually the initially preferred modality of treatment for stable patients. Studies have demonstrated angiographic healing in more than 90% of the patients with spontaneous coronary artery dissection, usually within a month. […] However, recurrent MI due to propagation of the dissection is not uncommon.

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

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

  Spontaneous coronary artery dissection (SCAD) is an acute noniatrogenic tear in the coronary arterial wall, leading to disruption of coronary blood flow and myocardial infarction. […] Despite growing awareness of this disease, there is a paucity of data on acute and long-term therapy. This review summarizes the existing literature on treatment of SCAD and describes a comprehensive management strategy. […] SCAD is primarily managed medically in clinically stable patients. […] Revascularization is recommended only for patients at high risk due to left main coronary artery dissection, ongoing ischemia, severely limited flow, hemodynamic instability, or refractory arrhythmia. […] Long-term management includes screening for fibromuscular dysplasia and other arteriopathies, monitoring for recurrence, and cardiac rehabilitation. […] Observational studies have consistently demonstrated that PCI in the setting of SCAD is associated with worse outcomes and high complication rates.

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

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

  Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndromes (ACS), with a higher incidence in younger female patients. […] Despite an exponential rise in the volume of SCAD-focused research and publications within the past decade, SCAD is still a poorly understood condition, with a paucity of randomised controlled trial data. […] This review discusses the pathophysiology, clinical presentation, diagnosis and management of SCAD alongside areas for future research. […] Invasive coronary angiography (ICA) is the current gold-standard investigation to diagnose SCAD. […] The American Heart Association consensus document has proposed an algorithm to manage acute SCAD. […] In the Canadian SCAD registry of 750 patients, 86.4% were managed conservatively, with only 2.3% of these patients subsequently requiring invasive treatment.

• #2 Spontaneous Coronary Artery Dissection (SCAD) – Victor Chang Cardiac Research Institute

  https://www.victorchang.edu.au/heart-disease/scad

  The goal of treatment for spontaneous coronary artery dissection (SCAD) is to restore blood flow to the heart. Treatment plans will depend on the severity of your condition including the size and location of the tear. Treatments may include: […] Inserting a stent to hold the artery open […] Surgery to bypass the damaged artery […] Medications such as aspirin, blood-thinning drugs, blood pressure drugs or medications to control chest pain, cholesterol drugs, beta blockers […] Checking and monitoring weaknesses in other blood vessels […] Cardiac rehabilitation programs. […] Ideally, cardiac rehabilitation for a SCAD should be started a few weeks after leaving hospital. Don’t worry if you or the patient has been out of hospital for longer than this, one should still go to cardiac rehab to get benefits. When deciding on a start date, the cardiac rehab staff will consider your heart condition and medical history. Fortunately, SCADs all heal within 30-35 days, but light rehab can be started before this. Be sure to inform the rehab staff that you’ve had a SCAD heart attack and not a traditional one, as the rehab program needs to be modified accordingly.

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

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

  The role of antiplatelet therapy in SCAD has been controversial. […] Antiplatelet use may therefore be beneficial in reducing this thrombus burden. […] In their scientific statements, the AHA and ESC suggested at least a single antiplatelet agent (aspirin), to be used acutely. […] However, even single antiplatelet therapy can create problems in younger female patients, with menorrhagia a frequent adverse event. […] The use of anticoagulation in the acute phase carries the same considerations as discussed in the antiplatelets section above. […] 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; RR of 0.51 (95% CI 0.33 -0.77, P=0.0013). […] Beta-blockers have therefore been recommended in all patients with SCAD.

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

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

  Early diagnosis is important for managing SCAD patients, because the use of unnecessary and potentially harmful pharmacologic therapies may be avoided. […] The role of antiplatelet therapy for SCAD patients not treated with stents is unclear. […] We routinely administer aspirin and clopidogrel for SCAD patients acutely; aspirin is then continued life-long and clopidogrel for up to 1 year. […] The role of anticoagulation for SCAD is controversial with the risk of dissection extension balanced by the potential benefit of resolving overlying thrombus and improving true lumen patency. […] Thrombolytic therapy should be avoided in SCAD, as there have been reports of harm and clinical deterioration due to extension of dissection and IMH. […] Beta-blockers reduce arterial shear stress and are presumably beneficial in reducing coronary arterial wall stress, similar to the benefits in aortic dissection.

• #2 Antiplatelet therapy in conservatively managed spontaneous coronary artery dissection: is less better?

  https://www.escardio.org/Working-groups/Working-Group-on-Thrombosis/Publications/Paper-of-the-Month/antiplatelet-therapy-in-conservatively-managed-spontaneous-coronary-artery-dissection-is-less-better

  At 12 months, the incidence of MACE was significantly greater in those that had received DAPT compared to SAPT (18.9% vs. 6.0%, adjusted hazard ratio 2.62, 95% confidence interval 1.22 to 5.61, p=0.013), driven by higher numbers of non-fatal MI (15.2% vs. 3.0%, p=0.009) and unplanned PCI (12.1% vs. 1.5%, p=0.0010). […] DAPT has been the cornerstone of ACS management for around 20 years, yet in the subset of patients with SCAD who do not have another indication such as PCI, it has remained uncertain as to whether it offers benefits over SAPT and practice has largely been based on physician preference. […] Now, intriguing data from the DISCO registry, the largest European case series of SCAD patients to date, has suggested that use of DAPT may be associated with a significantly greater incidence of cardiovascular events at 12 months when compared to SAPT.

• #2 Spontaneous Coronary Artery Dissection: Current State

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/03/02/11/28/Spontaneous-Coronary-Artery-Dissection-Current-State

  CABG is appropriate for left main and proximal dissections, PCI complications, or ongoing ischemia. […] Systemic anticoagulation with heparin should be avoided after the diagnosis of SCAD. Dual antiplatelet therapy is recommended after PCI. In patients managed medically, most experts recommend aspirin for at least a year, and some also recommend clopidogrel for a few months to a year. […] Cardiac rehabilitation is important for SCAD survivors. Severe restrictions in activity and weight lifting are not necessary, but extreme high-intensity exercise should be avoided.

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

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

  Medical therapy recommendations are summarized in Table 1. […] In the absence of randomized controlled trials to guide antiplatelet therapy for SCAD, data from traditional atherosclerotic ACS literature are extrapolated for this patient population. […] Thrombolysis is contraindicated in SCAD, as it may propagate dissection and lead to coronary rupture and cardiac tamponade. […] Beta-blockers are central to the management of acute aortic dissection, reducing shear stress on the vessel wall and minimizing risk of propagation. […] Chronic management of SCAD is based on several key principles, ie, screening for fibromuscular 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.

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

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

  Currently no randomised trial data is available to guide management. […] The Beta-blockers and Antiplatelet agents in patients with Spontaneous Coronary Artery Dissection (BA-SCAD) trial is currently enrolling and will address this important and unresolved knowledge gap. […] Post-SCAD chest pain is a common issue affecting more than half of SCAD survivors. […] Anti-anginal medications, such as nitrates or calcium channel blockers could be considered to treat chronic post SCAD chest pain. […] SCAD is one of the most common causes of MI in pregnant women with the post-partum period the most at-risk period. […] Pregnancy-related SCAD (P-SCAD) usually has higher incidences of ST elevation myocardial infarction, reduced left ventricular ejection fraction, involvement of the left main artery or multivessel SCAD.

• #2 SCAD Research, Inc Spontaneous Coronary Artery Dissection | What is SCAD

  https://scadresearch.org/about/

  Research has noted a substantial rate of spontaneous vascular healing and suggests a role for conservative management in stable SCAD patients who have preserved coronary flow. Conservative management includes 4-5 days of careful inpatient monitoring. If there is a complete artery blockage or the patient is unstable or having chest pains, an invasive procedure to treat SCAD such as stents or bypass surgery may be recommended. […] Statins do not appear to prevent another SCAD heart attack and one study found more recurrence in those taking statins. […] Physicians may recommend medication such as aspirin, blood pressure medication and medication to treat chest pain. […] SCAD can recur, so vigilance, evaluation of associated conditions, and staying up-to-date on emerging research is also important.

• #2 Spontaneous coronary artery dissection

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

  Indications for revascularisation include: complete vessel occlusion with thrombolysis In myocardial infarction (TIMI) 0 flow which is unlikely to resolve with medical treatment alone, left main stem involvement, ongoing ischaemia, recurrent chest pain, haemodynamic instability and sustained ventricular arrhythmias. […] PCI is the preferred revascularisation strategy, but is associated with significant challenges and has reported success rates of 50%. […] A conservative approach to stent implantation is preferred, with stenting of the proximal segment to seal the dissection entry, if present, and to limit the risk of dissection/haematoma propagation. […] CABG is considered for patients with left main stem dissections or when PCI has been unsuccessful or is not technically feasible. […] Most coronary dissections will heal spontaneously, and conservative treatment is recommended for uncomplicated cases.

• #2 SCAD Research, Inc Spontaneous Coronary Artery Dissection | What is SCAD

  https://scadresearch.org/about/

  How is SCAD treated? […] Although much has been learned about Spontaneous Coronary Artery Dissection (SCAD) in the past few years, there is still no known cause and no way to prevent SCAD. However the accurate differentiation of SCAD is crucial because the approach to acute and long term care is different. Specifically, patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) due to SCAD have technical success rates that are markedly reduced compared to PCI success rates for atherosclerosis ACS (62% vs. 92%). […] Research has identified several associated conditions and shown that patients with acute SCAD should be treated differently from other heart attack patients. Diagnosing and treating SCAD is more complex than traditional heart attacks. Conservative, non-invasive treatment is often best.

• #2 Spontaneous Coronary Artery Dissection (SCAD) | Treatment & Diagnosis | UH Harrington Heart & Vascular Institute | University Hospitals | Cleveland, Ohio | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/spontaneous-coronary-artery-dissection

  Bypass Surgery: In some cases, open-heart coronary artery bypass surgery may be need to restore adequate blood flow to the heart. In this procedure, the surgeon forms a new path for blood to reach the heart, thereby bypassing the damaged artery. To accomplish this, the surgeon removes part of a healthy blood vessel from the patient’s leg, arm or chest and connects it below and above the blocked arteries in the heart. Patient’s need several weeks to recover from open-heart surgery. […] If you are treated for SCAD, you’ll require follow-up appointments with your doctor to monitor for any changes in your condition, including the development of any new tears in your arteries. Your doctor may also recommend other types of care to help you recover and to prevent other health problems. Continuing care measures may include: Cardiac Rehabilitation: Cardiac rehabilitation is a tailored program of education and exercise designed to help you recover from a serious heart condition. The program typically includes monitored exercise, nutritional counseling, education and emotional support. Genetic Testing: For some patients, genetic testing may be recommended to screen for genetic mutations associated with vascular connective tissue disorders such as Loeys-Deitz syndrome, Marfan syndrome and vascular Ehlers-Danlos syndrome. Check Other Blood Vessels for Abnormalities: For many patients, the doctor will recommend imaging studies of the blood vessels outside of the chest to look for aneurysms, other dissections, and signs of the underlying condition fibromuscular dysplasia (FMD).

• #2 SCAD Research, Inc Spontaneous Coronary Artery Dissection | What is SCAD

  https://scadresearch.org/about/

  Following hospital discharge, enrolling in a cardiac rehabilitation program is a very important step in the recovery process both physically and emotionally. Cardiac rehab nurses are well equipped to advise regarding diet and exercise. Cardiac rehab sessions help to rebuild confidence after what can be an extremely frightening experience. […] A good diet, plenty of rest, stress reduction, realizing your limitations, help and support from loved ones, listening to your body, and a carefully controlled exercise program are all key factors for healing and recovery. Seek advice from your health care professional to develop a comprehensive plan.

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

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

  FMD screening has been advocated for in all patients with SCAD. […] The prevalence of FMD has been reported to be as high as 86%. […] It is recommended that all patients with SCAD following an ACS should be referred to cardiac rehabilitation. […] Current cardiac rehabilitation programs usually cater for older patients with atherosclerotic MI, and may be less suitable for younger patients with SCAD. […] SCAD-specific cardiac rehabilitation programs have been reported with encouraging results and should be used if available.

• #2 Spontaneous Coronary Artery Dissection | University of Ottawa Heart Institute

  https://www.ottawaheart.ca/heart-condition/spontaneous-coronary-artery-dissection

  Your doctor may recommend medications to restore blood flow and promote healing. These can include: Platelet Inhibitors: Drugs that reduce the number of blood-clotting platelets in your blood to reduce the risk of a clot forming in your torn artery. […] If your SCAD has blocked blood flow to your heart or if medications don’t control your chest pain, your doctor may recommend placing a tiny mesh tube called a stent inside your artery to hold it open. A stent helps restore blood flow to your heart muscle. […] If other treatments haven’t worked or if you have more than one tear in an artery, surgery may be the best treatment. A coronary artery bypass graft (CABG) is done to create a new passage for blood to reach your heart. […] After your treatment for SCAD, you will need to have follow-up appointments with a cardiologist. Your cardiologist may recommend other types of care to help you recover and to prevent further health problems.

• #2 FMD and SCAD (Spontaneous coronary artery dissection) – Fibromuscular Dysplasia

  https://www.fmd-be.be/fmd-and-scad-sudden-coronary-artery-dissection/

  Following a SCAD event, it is recommended to screen other arteries for signs of FMD or less frequently genetic or inflammatory arterial diseases. […] According to these observations, expert panels from Europe and the US have made the following recommendations: 1. Patients who have suffered a SCAD should undergo a one-time head to pelvis scan (by CTA, or MRA if contra-indicated) to screen for FMD lesions or other vascular abnormalities. […] Imaging of coronary arteries is not recommended in patients with FMD in the absence of chest pain (angina) or other suggestive symptoms.

• #2 4. Treating SCAD – SCAD Alliance

  https://scadalliance.org/scad-warrior-app/treating-scad-4/

  After your treatment for SCAD, you’ll need regular follow-up appointments with your doctor to monitor for any changes in your condition. Your doctor may also recommend other types of care to help you recover and to prevent other health problems. These may include: Undergoing cardiac rehabilitation. Cardiac rehabilitation is a customized program of exercise and education designed to help you recover from a serious heart condition, such as a heart attack caused by spontaneous coronary artery dissection (SCAD). Cardiac rehabilitation often includes monitored exercise, nutritional counseling, emotional support and education. Reviewing your family medical history. Some inherited conditions, such as the connective tissue disease Marfan syndrome, have been found to occur in people who experience spontaneous coronary artery dissection (SCAD). Your doctor may refer you to a genetic counselor to review your family medical history and determine whether genetic testing may be appropriate for you. Looking for weaknesses in other blood vessels. Your doctor may recommend using CT angiography to look for weaknesses and abnormalities in other blood vessels, such as fibromuscular dysplasia (FMD).

• #2 Spontaneous coronary artery dissection: A review for clinical and interventional cardiologists | Revista Portuguesa de Cardiologia

  https://www.revportcardiol.org/pt-spontaneous-coronary-artery-dissection-a-articulo-S0870255123000525

  PCI in SCAD patients is usually performed for high-risk presentations, including hemodynamic or electrical instability due to severe coronary flow limitation or high-risk anatomies (LM or multivessel proximal dissections). […] Overall, PCI for SCAD is associated with worse technical results and higher rates of complications compared to PCI for other indications. […] As for atherosclerotic coronary disease, CABG can be an option when large areas of myocardium are in jeopardy. […] When cardiogenic shock complicates SCAD, mechanical circulatory support should be considered as for non-SCAD ACS patients, according to international guidelines and consensus statements. […] A high level of suspicion should be present, and the diagnostic approach should include coronary angiography, as the substantial maternal morbidity rates outweigh the risk of fetal radiation exposure when proper shielding measures are taken.

• #2 Spontaneous coronary artery dissection (SCAD) // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/spontaneous-coronary-artery-dissection-scad

  The goals of SCAD treatment are to: […] Treatment may include medicines and a procedure or surgery to open the artery and restore blood flow. Sometimes SCAD heals on its own. […] The type of treatment for SCAD depends on your overall health and the size and location of the tear in the artery. […] Some people with SCAD only need medicines to treat symptoms. If chest pain or other symptoms continue, other treatments also might be needed. […] Medicines to treat SCAD may include: […] Some people with SCAD need a surgery or procedure to fix the artery and improve blood flow to the heart. These treatments may include: […] If you’ve had SCAD, talk to a health care professional before becoming pregnant. Pregnancy may not be safe after having SCAD. […] After treatment for SCAD, you need regular checkups with your health care team.

• #2 Antiplatelet Therapy Following Spontaneous Coronary Artery Dissection: Systemic Review | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.09.03.24312989v1.full-text

  Patients undergoing DAPT experienced higher rates of mortality, MACE, angina, and recurrent SCAD, as opposed to those on SAPT. […] The higher mortality rate observed in the DAPT group raises concerns regarding the safety and efficacy of this treatment approach for patients with SCAD. […] Exposing patients to DAPT following a diagnosis from MI as a consequence of SCAD appears to increase the risk of adverse cardiovascular events and mortality compared with SAPT. […] Mechanistic, and high-quality randomized clinical trials will be required to determine optimum antiplatelet for patients following a diagnosis of SCAD.

• #2 Management of SCAD | Spontaneous Coronary Artery Dissection (SCAD)

  https://scad.ubc.ca/management-of-scad/

  For a more detailed review about the medical treatment and management of SCAD please refer to Spontaneous coronary artery dissection A review. by Yip A., Saw J., in Cardiovasc Diagn Ther. 2015 Feb;5(1):37-48. […] The long-term prognosis for SCAD survivors after their initial SCAD presentation is good. Recurrent SCAD events, however, are frequent and these patients must be followed closely. Conservative medical management for stable patients with resolved ischemia is typical. Revascularization via percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) may be necessary for a small percentage of patients. […] Standard acute coronary syndrome (ACS) pharmaceutical agents may or may not be beneficial for SCAD. In addition, the use of antiplatelet therapy in the treatment of SCAD is also unclear for patients not treated with stents.

• #3 Spontaneous coronary artery dissection

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

  Spontaneous coronary artery dissection is an important cause of acute myocardial infarction, especially in young women. […] It is important to recognise SCAD, as patient characteristics and management differ substantially from typical ACS cases. SCAD patients are often younger, and more likely to be female without the classic cardiovascular risk factors. Results of revascularisation with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are suboptimal. Conservative management is the preferred option with spontaneous healing of the dissection in the majority of uncomplicated cases. […] Conservative management is preferred in stable patients with SCAD as most dissected segments will heal spontaneously. Medical therapy is based upon opinion, with no randomised clinical trials in this area. Initial treatment is similar to standard ACS patients with the use of dual antiplatelet agents, heparin and beta-blockers to preserve patency of the true lumen and prevent thrombotic occlusion.

• #3 Management of SCAD | Spontaneous Coronary Artery Dissection (SCAD)

  https://scad.ubc.ca/management-of-scad/

  A percentage of SCAD events involve intimal tears that are prothrombotic and would likely benefit from antiplatelet therapy. Therefore, we typically administer aspirin and clopidogrel for acute SCAD patients and follow-up with clopidogrel for 1 year and aspirin for life. […] Anticoagulation treatment for SCAD is controversial. While there is a risk of extending dissections this is balanced by the potential to resolve overlying thrombus and improve true lumen patency. […] Medical management of SCAD deviates from standard ACS therapy. In particular, thrombolytic therapy should be avoided for patients with SCAD. […] Beta-blockers offer benefits in aortic dissection by reducing arterial wall shear stress. Extrapolating these benefits, we routinely administer beta-blockers for SCAD, both acutely and long-term.

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

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

  Follow-up invasive coronary angiogram is reserved only for high-risk patients with recurrent symptoms, abnormal stress tests, or high-risk anatomies like the involvement of the left main, proximal LAD, or multivessel disease in the initial coronary angiography. […] Studies have shown that PCI for spontaneous coronary artery dissection can lead to suboptimal outcomes and increased risk of complications. […] CABG is reserved for spontaneous coronary artery dissection patients after attempted PCI has failed, with left main or proximal dissections, or refractory ischemia, despite conservative management. […] Medical management of ACS due to SCAD is different from atherosclerotic ACS. […] Beta-blocker therapy has been shown to lower the incidence of recurrent spontaneous coronary artery dissection and should always be prescribed. […] Recurrence of SCAD is defined as a new dissection event, usually at a different location. Beta-blockers have been shown to prevent a recurrence after an index event.

• #3 Spontaneous Coronary Artery Dissection (SCAD) Heart Attack Symptoms & Treatment

  https://resources.healthgrades.com/right-care/heart-health/spontaneous-coronary-artery-dissection-scad

  Spontaneous coronary artery dissection treatment depends on the size and location of the tear. Treatment options for SCAD are different from typical heart attack treatments. Many only require medications to relieve symptoms and promote healing. Some will require a procedure to clear the block in the artery or bypass the block. […] Treating SCAD is different from treating a typical heart attack due to atherosclerosis. Treatment can be more complex than other types of heart attack as well. […] Treatment options depend on the size and location of the tear, along with the amount of blockage. When blood flow is stable, doctors usually opt for conservative medical management. It has better outcomes compared to percutaneous coronary intervention (PCI). […] PCI—or angioplasty—is a catheter-based procedure to reopen blocked coronary arteries. The success rate in SCAD is much lower than with atherosclerotic heart attack. Only 62% of SCAD patients have favorable outcomes with PCI compared to 92% of typical heart attack patients. The risk of complications is also higher in SCAD. However, PCI or bypass surgery may be necessary in a SCAD heart attack if the artery is completely blocked or blood flow is unstable.

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

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

  FMD screening has been advocated for in all patients with SCAD. […] The prevalence of FMD has been reported to be as high as 86%. […] It is recommended that all patients with SCAD following an ACS should be referred to cardiac rehabilitation. […] Current cardiac rehabilitation programs usually cater for older patients with atherosclerotic MI, and may be less suitable for younger patients with SCAD. […] SCAD-specific cardiac rehabilitation programs have been reported with encouraging results and should be used if available.

• #3 Azthena logo with the word Azthena

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

  Prevention includes regular adequate physical exercise, decreasing body mass index, treating high blood pressure, stopping smoking, and adopting a healthy diet to decrease cholesterol and blood pressure. […] Both the use of medication and exercise are considered to be roughly effective. […] Moreover, the risk of coronary artery disease can be reduced by approximately 1/4 through high levels of physical activity.

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