Spontaneous coronary artery dissection: an unpredictable event.
Alexandra SmirnovaFlaminia AlibertiClaudia CavaliereIlaria GattiViviana VilardoCarmelina GiorgianniChiara CassaniAlessandra RepettoNupoor NarulaLorenzo GiulianiMario UrtisYukio OzakiFrancesco PratiArbustini EloisaMichela FerrariPublished in: European heart journal supplements : journal of the European Society of Cardiology (2023)
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.
Keyphrases
- percutaneous coronary intervention
- st segment elevation myocardial infarction
- coronary artery
- acute myocardial infarction
- acute coronary syndrome
- polycystic ovary syndrome
- cardiovascular events
- coronary artery disease
- pregnancy outcomes
- cardiac arrest
- st elevation myocardial infarction
- antiplatelet therapy
- pulmonary artery
- stress induced
- left ventricular
- intellectual disability
- risk factors
- heart failure
- cervical cancer screening
- breast cancer risk
- atrial fibrillation
- cardiovascular disease
- cardiopulmonary resuscitation
- stem cells
- type diabetes
- insulin resistance
- metabolic syndrome
- pulmonary hypertension
- dna methylation
- preterm birth
- congenital heart disease
- early life
- emergency department
- genome wide
- copy number
- depressive symptoms
- heat stress
- bone marrow
- replacement therapy