While increasing recognition of spontaneous coronary artery dissection (SCAD) has improved understanding of the disease process and highlighted shortfalls in evidence, prospective and collaborative research across centers and geography are still needed to advance the science, according to a state-of-the-art review published Aug. 17 in the Journal of the American College of Cardiology.

Sharonne N. Hayes, MD, FACC, et al., provide a clinical update on the diagnosis and management of patients with SCAD and highlight high-priority knowledge gaps that must be addressed. The authors note that over the past decade, SCAD has emerged as an important cause of myocardial infarction, particularly among younger women.

According to the review, many SCAD patients experience substantial post-SCAD symptoms, recurrent SCAD and psychosocial distress. However, considerable uncertainty remains about optimal management of associated conditions, risk stratification, recommendations for physical activity, reproductive planning and the role of genetic evaluations.

The authors note that some of the specific high-impact areas for further study include effects of sex, gender, race, and ethnicity on susceptibility to SCAD and the contributing roles of endogenous and exogenous hormones; identification of appropriate indications and optimal techniques for revascularization; identification and individualization of risk factors for recurrent SCAD and other major adverse cardiovascular events, including temporal risk trends; and more.

"There must be continued education to enhance awareness of the signs, symptoms, and importance of taking action to expeditiously evaluate symptoms of heart disease and accurately diagnose the etiology of [acute coronary syndrome], especially among women," the authors conclude.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement

Keywords: Acute Coronary Syndrome, Risk Factors, Coronary Vessel Anomalies, Vascular Diseases, Myocardial Infarction, Risk Assessment

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