Table 1:

Key differences in the demographics, associated conditions and management of spontaneous coronary artery dissection compared with atherosclerotic acute coronary syndrome

CharacteristicSCADAtherosclerotic ACS
Demographics
SexMore frequent in womenMore frequent in men
HypertensionLess commonCommon
DyslipidemiaLess commonCommon
SmokingLess commonCommon
PregnancyCommonUncommon
Emotional or physical stressCommonUncommon
MigrainesCommonUncommon
FMDCommonUncommon
Revascularization
PCI (balloon angioplasty with or without stenting)

  • Conservative strategy

  • Consider PCI if hemodynamically unstable, large territory or multiple coronary arteries with SCAD

Recommended
Coronary artery bypass graftWhen PCI is not possibleWhen PCI is not possible
Medical therapy
Antiplatelet agents

  • Lack of evidence to guide therapy

  • Dual antiplatelet therapy for 1 year if a stent is placed

  • In the absence of stent implantation, use of single v. dual antiplatelet therapy is controversial

Dual antiplatelet therapy for 1 year
β-blockersRecommendedRecommended
ACE inhibitorsNo clear benefitRecommended
ARBsNo clear benefitRecommended
StatinsNo clear benefitRecommended
Lifestyle
DietNo restrictionsHealthy heart diet
Physical activityModerate intensity exerciseExercise intensity as tolerated
Stress managementRecommendedRecommended
Smoking cessationRecommendedRecommended
Additional screening
FMD screeningComputed tomography angiogram from head to pelvis recommendedNot required

  • Note: ACE = angiotensin-converting-enzyme, ACS = acute coronary syndrome, ARB = angiotensin II receptor blocker, FMD = fibromuscular dysplasia, PCI = percutaneous coronary intervention, SCAD = spontaneous coronary artery dissection.