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Unpredictability of Medically Treated SCAD
Study Questions:
What is the natural history of medically treated spontaneous coronary artery dissection (SCAD)?
Methods:
The investigators reported on four 40-year-old women presenting at a single center with acute coronary syndrome (ACS) with angiographic features of SCAD.
Results:
Because of the absence of symptoms and/or high-risk features at the time of catheterization, all four patients were treated medically. However, two patients required urgent repeated coronary angiography due to the occurrence of cardiogenic shock and of angina at rest, with evidence of severe progression of SCAD up to left main and proximal circumflex, respectively, with the need for subsequent extensive percutaneous transluminal coronary angioplasty with multiple drug-eluting stent/bioresorbable scaffold implantation. On the contrary, the other two patients underwent elective in-hospital angiographic control, which showed complete SCAD healing.
Conclusions:
The authors concluded that due to the paucity of prospective data, management of SCAD constitutes an unmet need in clinical practice, and close follow-up is indicated.
Perspective:
These four cases serve as a reminder of the unpredictability of SCAD evolution after an initial management decision, and the importance of a close surveillance of patients with this condition. Larger multicenter cohort studies of SCAD may help to further define optimal management.
Keywords: Acute Coronary Syndrome, Angina Pectoris, Angina, Stable, Angioplasty, Balloon, Coronary, Cardiac Catheterization, Coronary Angiography, Coronary Vessel Anomalies, Dissection, Drug-Eluting Stents, Secondary Prevention, Shock, Cardiogenic, Vascular Diseases
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