Spontaneous Coronary Artery Dissection

  • Marysia S. Tweet
  • Rajiv Gulati
  • Sharonne N. Hayes
Management of Acute Coronary Syndromes (AS Jaffe, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Management of Acute Coronary Syndromes


Spontaneous coronary artery dissection is an important etiology of nonatherosclerotic acute coronary syndrome, myocardial infarction, and sudden death. Innovations in the catheterization laboratory including optical coherence tomography and intravascular ultrasound have enhanced the ability to visualize intimal disruption and intramural hematoma associated with SCAD. Formerly considered “rare,” these technological advances and heightened awareness suggest that SCAD is more prevalent than prior estimates. SCAD is associated with female sex, young age, extreme emotional stress, or extreme exertion, pregnancy, and fibromuscular dysplasia. The clinical characteristics and management strategies of SCAD patients are different than for atherosclerotic heart disease and deserve specific consideration. This review will highlight recent discoveries about SCAD as well as describe current efforts to elucidate remaining gaps in knowledge.


Spontaneous coronary artery dissection Myocardial infarction Acute coronary syndrome Women Fibromuscular dysplasia Pregnancy 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.•
    Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, et al. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012;126(5):579–88. doi:10.1161/CIRCULATIONAHA.112.105718. This series reports SCAD prevalence, associated factors, and acute and long-term outcomes. CrossRefPubMedGoogle Scholar
  2. 2.
    Vanzetto G, Berger-Coz E, Barone-Rochette G, Chavanon O, Bouvaist H, Hacini R, et al. Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients. Eur J Cardiothorac Surg. 2009;35(2):250–4. doi:10.1016/j.ejcts.2008.10.023.CrossRefPubMedGoogle Scholar
  3. 3.
    Mortensen KH, Thuesen L, Kristensen IB. Christiansen EH. Spontaneous Coron Artery Dissection: a W Den Heart Registry study Catheter Cardiovasc Interv. 2009;74(5):710–7.Google Scholar
  4. 4.
    Nakashima T, Noguchi T, Haruta S, Yamamoto Y, Oshima S, Nakao K, et al. Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the Angina Pectoris–Myocardial Infarction Multicenter Investigators in Japan. Int J Cardiol. 2016;207:341–8. doi:10.1016/j.ijcard.2016.01.188.CrossRefPubMedGoogle Scholar
  5. 5.
    Tweet MS, Gulati R, Hayes SN. What clinicians should know about spontaneous coronary artery dissection. Mayo Clin Proc. 2015;90(8):1125–30. doi:10.1016/j.mayocp.2015.05.010.CrossRefPubMedGoogle Scholar
  6. 6.
    Tweet MS, Gulati R, Aase LA, Hayes SN. Spontaneous coronary artery dissection: a disease-specific, social networking community-initiated study. Mayo Clin Proc. 2011;86(9):845–50.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Alfonso F, Paulo M, Dutary J. Endovascular imaging of angiographically invisible spontaneous coronary artery dissection. JACC Cardiovasc Interv. 2012;5(4):452–3. doi:10.1016/j.jcin.2012.01.016.CrossRefPubMedGoogle Scholar
  8. 8.
    Alfonso F, Paulo M, Gonzalo N, Dutary J, Jimenez-Quevedo P, Lennie V, et al. Diagnosis of spontaneous coronary artery dissection by optical coherence tomography. J Am Coll Cardiol. 2012;59(12):1073–9. doi:10.1016/j.jacc.2011.08.082.CrossRefPubMedGoogle Scholar
  9. 9.•
    Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014;7(5):645–55. doi:10.1161/circinterventions.114.001760. This series reviews characteristics and outcomes in a cohort of SCAD patients. CrossRefPubMedGoogle Scholar
  10. 10.
    Rashid HNZ, Wong DTL, Wijesekera H, Gutman SJ, Shanmugam VB, Gulati R, et al. Incidence and characterisation of spontaneous coronary artery dissection as a cause of acute coronary syndrome—a single-centre Australian experience. Int J Cardiol. 2016;202:336–8. doi:10.1016/j.ijcard.2015.09.072.CrossRefPubMedGoogle Scholar
  11. 11.
    Lettieri C, Zavalloni D, Rossini R, Morici N, Ettori F, Leonzi O, et al. Management and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol. 2015;116(1):66–73. doi:10.1016/j.amjcard.2015.03.039.CrossRefPubMedGoogle Scholar
  12. 12.
    Rogowski S, Maeder MT, Weilenmann D, Haager PK, Ammann P, Rohner F, et al. Spontaneous coronary artery dissection. Catheter Cardiovasc Interv. 2015. doi:10.1002/ccd.26383. n/a-n/a.PubMedGoogle Scholar
  13. 13.
    Tweet MS, Gulati R, Hayes SN. What clinicians should know about spontaneous coronary artery dissection. Mayo Clin Proc. 2015;90(8):1125–30.CrossRefPubMedGoogle Scholar
  14. 14.
    Saw J, Aymong E, Mancini GBJ, Sedlak T, Starovoytov A, Ricci D. Nonatherosclerotic coronary artery disease in young women. Can J Cardiol. 2014;30(7):814–9. doi:10.1016/j.cjca.2014.01.011.CrossRefPubMedGoogle Scholar
  15. 15.
    Prasad M, Tweet MS, Hayes SN, Leng S, Liang JJ, Eleid MF, et al. Prevalence of extracoronary vascular abnormalities and fibromuscular dysplasia in patients with spontaneous coronary artery dissection. Am J Cardiol. 2015;115(12):1672–7. doi:10.1016/j.amjcard.2015.03.011.CrossRefPubMedGoogle Scholar
  16. 16.
    Henkin S, Negrotto SM, Tweet MS, Kirmani S, Deyle DR, Gulati R, et al. Spontaneous coronary artery dissection and its association with heritable connective tissue disorders. Heart. 2016. doi:10.1136/heartjnl-2015-308645.PubMedGoogle Scholar
  17. 17.
    Saw J. Coronary angiogram classification of spontaneous coronary artery dissection. Catheter Cardiovasc Interv. 2014;84(7):1115–22. doi:10.1002/ccd.25293.CrossRefPubMedGoogle Scholar
  18. 18.••
    Eleid M, Guddeti R, Tweet M, Lerman A, Singh M, Best P, et al. Coronary artery tortuosity in spontaneous coronary artery dissection: angiographic characteristics and clinical implications. Circ Cardiovasc Interv. 2014. doi:10.1161/CIRCINTERVENTIONS.114.001676. This is the largest angiographic SCAD series, which demonstrated the novel finding of coronary tortuosity. Google Scholar
  19. 19.
    Desai S, Sheppard M. Sudden cardiac death: look closely at the coronaries for spontaneous dissection which can be missed. A study of 9 cases. Am J Forensic Med Pathol. 2012;33(1):26–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Roura G, Ariza-Solé A, Rodriguez-Caballero IF, Gomez-Lara J, Ferreiro JL, Romaguera R et al. Noninvasive follow-up of patients with spontaneous coronary artery dissection with CT angiography. JACC: Cardiovasc Imaging. doi:http://dx.doi.org/10.1016/j.jcmg.2015.06.011
  21. 21.••
    Tweet MS, Eleid MF, Best PJM, Lennon RJ, Lerman A, Rihal CS, et al. Spontaneous coronary artery dissection: revascularization versus conservative therapy. Circ Cardiovasc Interv. 2014;7(6):777–86. doi:10.1161/circinterventions.114.001659. This large retrospective series provides guidance regarding acute management strategies in SCAD patients. CrossRefPubMedGoogle Scholar
  22. 22.
    Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25, Part B):2889–934. doi:10.1016/j.jacc.2013.11.002.CrossRefPubMedGoogle Scholar
  23. 23.
    Dunlay SM, Pack QR, Thomas RJ, Killian JM, Roger VL. Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction. Am J Med. 2014;127(6):538–46. doi:10.1016/j.amjmed.2014.02.008.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Amsterdam EA, Wenger NK, Brindis RG, Casey Jr DE, Ganiats TG, Holmes Jr DR, et al. AHA/ACC guideline for the management of patients with Non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139–228. doi:10.1016/j.jacc.2014.09.017.CrossRefPubMedGoogle Scholar
  25. 25.
    Krittanawong C, Tweet MS, Hayes SE, Bowman MJ, Gulati R, Squires RW, et al. Usefulness of cardiac rehabilitation after spontaneous coronary artery dissection. Am J Cardiol. 2016. doi:10.1016/j.amjcard.2016.02.034.PubMedGoogle Scholar
  26. 26.
    Silber TC, Tweet MS, Bowman MJ, Hayes SN, Squires RW. Cardiac rehabilitation after spontaneous coronary artery dissection. J Cardiopulm Rehab Preven. 2015;35(5):328–33. doi:10.1097/hcr.0000000000000111.CrossRefGoogle Scholar
  27. 27.
    Chou AY, Prakash R, Rajala J, Birnie T, Isserow S, Taylor CM, et al. The first dedicated cardiac rehabilitation program for patients with spontaneous coronary artery dissection: description and initial results. Can J Cardiol. 2016;32(4):554–60. doi:10.1016/j.cjca.2016.01.009.CrossRefPubMedGoogle Scholar
  28. 28.
    Lie JT, Berg KK. Isolated fibromuscular dysplasia of the coronary arteries with spontaneous dissection and myocardial infarction. Hum Pathol. 1987;18:654–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Michelis KC, Olin JW, Kadian-Dodov D, d’Escamard V, Kovacic JC. Coronary artery manifestations of fibromuscular dysplasia. J Am Coll Cardiol. 2014;64(10):1033–46. doi:10.1016/j.jacc.2014.07.014.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Saw J, Ricci D, Starovoytov A, Fox R, Buller CE. Spontaneous coronary artery dissection: prevalence of predisposing conditions including fibromuscular dysplasia in a tertiary center cohort. J Am Coll Cardiol Cardiovasc Interv. 2013;6(1):44–52. doi:10.1016/j.jcin.2012.08.017.CrossRefGoogle Scholar
  31. 31.
    Liang JJ, Prasad M, Tweet MS, Hayes SN, Gulati R, Breen JF, et al. A novel application of CT angiography to detect extracoronary vascular abnormalities in patients with spontaneous coronary artery dissection. J Cardiovasc Comput Tomogr. 2014;8(3):189–97. doi:10.1016/j.jcct.2014.02.001.CrossRefPubMedGoogle Scholar
  32. 32.••
    Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH, et al. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation. 2014;129(9):1048–78. doi:10.1161/01.cir.0000442577.96802.8c. This AHA Scientific Statement provides a thorough review of what is known and unknown about fibromuscular dysplasia and offers guidance regarding management. CrossRefPubMedGoogle Scholar
  33. 33.
    Goel K, Tweet M, Olson TM, Maleszewski JJ, Gulati R, Hayes SN. Familial spontaneous coronary artery dissection: evidence for genetic susceptibility. JAMA Intern Med. 2015;175(5):821–6. doi:10.1001/jamainternmed.2014.8307.CrossRefPubMedGoogle Scholar
  34. 34.
    Nishiguchi T, Tanaka A, Ozaki Y, Taruya A, Fukuda S, Taguchi H, et al. Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2013. doi:10.1177/2048872613504310.PubMedGoogle Scholar
  35. 35.
    Elkayam U, Jalnapurkar S, Barakkat MN, Khatri N, Kealey AJ, Mehra A, et al. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation. 2014;129(16):1695–702. doi:10.1161/circulationaha.113.002054.CrossRefPubMedGoogle Scholar
  36. 36.
    Tweet MS, Hayes SN, Gulati R, Rose CH, Best PJM. Pregnancy after spontaneous coronary artery dissection: a case series. Ann Intern Med. 2015;162(8):598–600. doi:10.7326/l14-0446.CrossRefPubMedGoogle Scholar
  37. 37.
    Liang JJ, Tweet MS, Hayes SE, Gulati R, Hayes SN. Prevalence and predictors of depression and anxiety among survivors of myocardial infarction due to spontaneous coronary artery dissection. J Cardiopulm Rehabil Preven. 2014;34(2):138–42.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Marysia S. Tweet
    • 1
  • Rajiv Gulati
    • 1
  • Sharonne N. Hayes
    • 1
  1. 1.Department of Internal Medicine, Division of Cardiovascular DiseasesMayo ClinicRochesterUSA

Personalised recommendations