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      Current state-of-play in spontaneous coronary artery dissection.

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          Abstract

          For over 80 years, spontaneous coronary artery dissection (SCAD) has been recognised as a cause of myocardial infarction. SCAD is described as a non-iatrogenic, non-atherosclerotic coronary artery dissection, resulting in formation of a false lumen or intramural haematoma in the coronary artery wall that compresses the true lumen, often compromising myocardial blood flow. In early literature, the incidence of SCAD in acute coronary syndrome (ACS) was underestimated. Recent advances in awareness and widespread early angiographic investigation in ACS has led to important shifts in our understanding of the prevalence, predisposing causes, natural history, aetiology, clinical and angiographic features, management, and prognosis of SCAD. It is now well understood that SCAD predominantly affects women and is responsible for around 20% of ACS presentations in females below the age of 60. Despite this, SCAD is still often overlooked and misdiagnosed as atherosclerotic disease. Misdiagnosis is multifactorial; with contributing factors including a low clinical index of suspicion, particularly in young females, a lack of clinician familiarity with angiographic variants, and limitations of angiography. Although increasing evidence suggests that optimal management is distinct from atherosclerotic coronary artery disease, many questions remain unanswered regarding the pathogenesis and optimal treatment of SCAD, heralding prospective research to answer these questions. This review aims to give a current clinical perspective on SCAD and highlight the importance of familiarity and vigilance with this condition when diagnosing and treating ACS.

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          Author and article information

          Journal
          Cardiovasc Diagn Ther
          Cardiovascular diagnosis and therapy
          AME Publishing Company
          2223-3652
          2223-3652
          Jun 2019
          : 9
          : 3
          Affiliations
          [1 ] Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.
          [2 ] Adelaide Medical School, University of Adelaide, Adelaide, Australia.
          [3 ] Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.
          [4 ] Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
          [5 ] Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
          Article
          cdt-09-03-281
          10.21037/cdt.2019.04.03
          6603494
          31275818

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