Intensive care medicine

Artery dissection

Biology

Acute coronary syndrome

Surgery

Artery

Cardiology

Psychiatry

Scad

Risk stratification

Genetics

Dissection (medical)

Myocardial infarction

Internal medicine

Psychosocial

Coronary angiography

Distress

Medicine

Clinical psychology

Pregnancy

Journal of the American College of Cardiology

Over the past decade, spontaneous coronary artery dissection (SCAD) has emerged as an important cause of myocardial infarction, particularly among younger women. The pace of knowledge acquisition has been rapid, but ongoing challenges include accurately diagnosing SCAD and improving outcomes. Many SCAD patients experience substantial post-SCAD symptoms, recurrent SCAD, and psychosocial distress. Considerable uncertainty remains about optimal management of associated conditions, risk stratification and prevention of complications, recommendations for physical activity, reproductive planning, and the role of genetic evaluations. This review provides a clinical update on the diagnosis and management of patients with SCAD, including pregnancy-associated SCAD and pregnancy after SCAD, and highlight high-priority knowledge gaps that must be addressed. • SCAD is an important cause of MI, with unique associations and outcomes. • Chest pain after SCAD is common; an initial noninvasive approach for stable patients is preferred. • Evidence remains sparse for counseling about recurrence risk, physical activity, mental health, and reproductive issues. • Prospective and collaborative research across centers and geography are needed to advance the science.

Spontaneous Coronary Artery Dissection