TY - JOUR
T1 - Spontaneous coronary artery dissection
T2 - an unpredictable event
AU - Smirnova, Alexandra
AU - Aliberti, Flaminia
AU - Cavaliere, Claudia
AU - Gatti, Ilaria
AU - Vilardo, Viviana
AU - Giorgianni, Carmelina
AU - Cassani, Chiara
AU - Repetto, Alessandra
AU - Narula, Nupoor
AU - Giuliani, Lorenzo
AU - Urtis, Mario
AU - Ozaki, Yukio
AU - Prati, Francesco
AU - Arbustini, Eloisa
AU - Ferrari, Michela
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of acute coronary syndrome that predominantly affects women in adulthood and is the leading cause of acute myocardial infarction in pregnancy. The most common clinical presentation is ST-segment elevation myocardial infarction (STEMI) or non-STEMI, followed by cardiogenic shock (∼2%), sudden cardiac death (0.8% in autopsy series), cardiac arrest, ventricular arrhythmias (∼5%), and Takotsubo syndrome. The prevalence of SCAD in the general population is largely uncertain due to underdiagnosis. Oral contraceptives, post-menopausal therapy, and infertility treatments are recognized associated factors. The pathological substrates (fibromuscular dysplasia) and triggers (especially emotional stress) are commonly present in affected women. The few cases with a precise genetic aetiology occur in the context of syndromic and non-syndromic connective tissue diseases. The only true certainty in SCAD is the overwhelming prevalence in women. The first event as well as the recurrence (up to 30%, which varies depending on the definition) is largely unpredictable. The treatment strategy is highly individualized and requires extensive additional study in order to optimize outcomes and prevent major adverse cardiovascular events in affected individuals. We have known about SCAD for nearly a century, but we still do not know how best to prevent, diagnose, and treat it, making SCAD a highly important and unmet clinical need.
AB - Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of acute coronary syndrome that predominantly affects women in adulthood and is the leading cause of acute myocardial infarction in pregnancy. The most common clinical presentation is ST-segment elevation myocardial infarction (STEMI) or non-STEMI, followed by cardiogenic shock (∼2%), sudden cardiac death (0.8% in autopsy series), cardiac arrest, ventricular arrhythmias (∼5%), and Takotsubo syndrome. The prevalence of SCAD in the general population is largely uncertain due to underdiagnosis. Oral contraceptives, post-menopausal therapy, and infertility treatments are recognized associated factors. The pathological substrates (fibromuscular dysplasia) and triggers (especially emotional stress) are commonly present in affected women. The few cases with a precise genetic aetiology occur in the context of syndromic and non-syndromic connective tissue diseases. The only true certainty in SCAD is the overwhelming prevalence in women. The first event as well as the recurrence (up to 30%, which varies depending on the definition) is largely unpredictable. The treatment strategy is highly individualized and requires extensive additional study in order to optimize outcomes and prevent major adverse cardiovascular events in affected individuals. We have known about SCAD for nearly a century, but we still do not know how best to prevent, diagnose, and treat it, making SCAD a highly important and unmet clinical need.
KW - Fibromuscular dysplasia
KW - Genetics
KW - Pregnancy-related death
KW - Spontaneous coronary artery dissection
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U2 - 10.1093/eurheartjsupp/suad059
DO - 10.1093/eurheartjsupp/suad059
M3 - Article
AN - SCOPUS:85180972662
SN - 1520-765X
VL - 25
SP - B7-B11
JO - European Heart Journal, Supplement
JF - European Heart Journal, Supplement
ER -