Perspective:

The current study adds much needed data to the SCAD literature. Although this is a retrospective analysis and risks missed SCAD diagnoses, it provides some important insights into patients presenting with STEMI secondary to SCAD. The authors re-confirm that this diagnosis is most often seen in younger women with STEMI and more likely to involve more proximal segments of the coronary tree (LM and LAD) at the time of presentation. Interestingly, about two thirds of patients underwent revascularization and a minority were treated conservatively, reflecting the more acute presentation of STEMI and need for more urgent mechanical revascularization. Although expert consensus recommends conservative management in stable patients, it is reassuring to know that in this more unstable presentation when PCI was necessary, >90% of patients who underwent PCI had a successful outcome. Furthermore, the overall outcomes at 3 years were favorable, although longer term follow-up will be needed. Although more study is needed to outline optimal revascularization strategies in SCAD patients, this study provides reassurance in support of mechanical revascularization when needed for patients presenting with STEMI secondary to SCAD.