Spontaneous coronary artery dissection treatment approach

	Spontaneous Coronary Artery Dissection Microchapters
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Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Spontaneous coronary artery dissection from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Approach
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Angiography
CT
MRI
Echocardiography
Other Imaging Findings
Other Diagnostic Studies
Treatment
Treatment Approach
Medical Therapy
Percutaneous Coronary Intervention
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Type 1 Case 1; Case 2; Case 3; Case 4; Case 5; Case 6; Case 7; Type 2A Case 1; Case 2; Case 3; Case 4; Case 5; Case 6; Type 2B Case 1; Case 2; Case 3; Case 4; Type 3 Case 1; Case 2; Case 3; Case 4; Case 5; Case 6;

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.

Synonyms and keywords: SCAD

Overview

Pharmacologic medical therapies for spontaneous coronary artery dissection pursues three main goals:^[1]
- Antianginal therapy
- Prevention of recurrence
- Assessment and management of extra coronary vascular abnormalities
- Improvement of quality of life

To manage of chest pain in patients with SCAD consider the followings:^[1]
- Antianginal medications
- Consider further testing to rule out underlying ischemia
- Consider other possible diagnoses

To reduce the risk of SCAD recurrence, the following should be considered:^[1]
- Beta-blocker therapy
- Management of hypertension
- Maintaining physical activity

To identify patients with SCAD-associated conditions, imaging with CT angiography or magnetic resonance angiography is recommended.^[1]

To improve the quality of life in patients with SCAD, consider:^[1]
- Cardiac rehabilitation referral
- Manage patients comorbidities

Algorithm for management of acute spontaneous coronary artery dissection.^[2]

Management of Acute Spontaneous Coronary Artery Dissection

Clinically stable
without high-risk anatomy

Clinically stable with high-risk anatomy
(i.e., left main or proximal 2-vessel dissection)

Active/ongoing ischemia
or hemodynamic instability

❑ Conservative therapy
❑ Monitor as inpatient 3–5 days

❑ Consider CABG
❑ Conservative Rx may be reasonable

❑ Consider PCI if feasible, OR
❑ Urgent CABG (based on technical considerations and local expertise)

Abbreviations: CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention; Rx, management.

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 Kim, Esther S.H.; Longo, Dan L. (2020). "Spontaneous Coronary-Artery Dissection". New England Journal of Medicine. 383 (24): 2358–2370. doi:10.1056/NEJMra2001524. ISSN 0028-4793.
↑ Hayes, Sharonne N.; Kim, Esther S.H.; Saw, Jacqueline; Adlam, David; Arslanian-Engoren, Cynthia; Economy, Katherine E.; Ganesh, Santhi K.; Gulati, Rajiv; Lindsay, Mark E.; Mieres, Jennifer H.; Naderi, Sahar; Shah, Svati; Thaler, David E.; Tweet, Marysia S.; Wood, Malissa J. (2018). "Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association". Circulation: CIR.0000000000000564. doi:10.1161/CIR.0000000000000564. ISSN 0009-7322.