Acute and Chronic Management of Spontaneous Coronary Artery Dissection
Abstract
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized, non-atherosclerotic cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk factors. SCAD results from an intramural hematoma or intimal tear that compresses the coronary lumen, leading to myocardial ischemia. Diagnosis is critical, as management differs fundamentally from atherosclerotic ACS. Conservative therapy is preferred for hemodynamically stable patients due to high rates of spontaneous vessel healing; revascularization is reserved for ongoing ischemia, hemodynamic instability or left main/multivessel involvement. Long-term management focuses on reducing recurrence risk through β-blocker therapy, strict blood pressure control, and individualized cardiac rehabilitation. Although outcomes are generally favorable, recurrence occurs in up to 20% of patients. Ongoing research is needed to refine antiplatelet strategies, identify genetic and vascular risk factors, and optimize preventive care.
Related
- Spontaneous coronary artery dissection presenting as myocardial infarction in a postmenopausal woman
- Double-Vessel Involvement: A Case Report of Simultaneous Left Anterior Descending Artery (LAD) and Right Coronary Artery (RCA) Spontaneous Coronary Artery Dissection Causing Acute Coronary Syndrome
- Recurrent Spontaneous Coronary Artery Dissection.
- Postpartum Left Main Spontaneous Coronary Artery Dissection With Shock, Requiring Surgery and Extracorporeal Membrane Oxygenation.
- A Bidirectional Relationship Between Spontaneous Coronary Artery Dissection and Stress-Induced Cardiomyopathy in a Perimenopausal Woman: A Case Report.
BibTeX
@article{kato2026acute,
title = {{Acute and Chronic Management of Spontaneous Coronary Artery Dissection}},
author = {Ken Kato and Kayo Yamamoto and Ko Miyakoda and Nao Tamura and Kazuya Tateishi and Yuichi Saito and Hideki Kitahara and Yoshio Kobayashi},
journal = {Circulation Journal},
year = {2026},
month = jul,
doi = {10.1253/circj.cj-25-0966},
url = {https://www.jstage.jst.go.jp/article/circj/90/8/90_CJ-25-0966/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Acute and Chronic Management of Spontaneous Coronary Artery Dissection
AU - Ken Kato
AU - Kayo Yamamoto
AU - Ko Miyakoda
AU - Nao Tamura
AU - Kazuya Tateishi
AU - Yuichi Saito
AU - Hideki Kitahara
AU - Yoshio Kobayashi
PY - 2026
DA - 2026/07/24
JO - Circulation Journal
DO - 10.1253/circj.cj-25-0966
UR - https://www.jstage.jst.go.jp/article/circj/90/8/90_CJ-25-0966/_article
AB - Spontaneous coronary artery dissection (SCAD) is an increasingly recognized, non-atherosclerotic cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk factors. SCAD results from an intramural hematoma or intimal tear that compresses the coronary lumen, leading to myocardial ischemia. Diagnosis is critical, as management differs fundamentally from atherosclerotic ACS. Conservative therapy is preferred for hemodynamically stable patients due to high rates of spontaneous vessel healing; revascularization is reserved for ongoing ischemia, hemodynamic instability or left main/multivessel involvement. Long-term management focuses on reducing recurrence risk through β-blocker therapy, strict blood pressure control, and individualized cardiac rehabilitation. Although outcomes are generally favorable, recurrence occurs in up to 20% of patients. Ongoing research is needed to refine antiplatelet strategies, identify genetic and vascular risk factors, and optimize preventive care.
SN - 1347-4820
SN - 1346-9843
ER -