How and when to suspect spontaneous coronary artery dissection: novel insights from a single-centre series on prevalence and angiographic appearance

Spontaneous coronary artery dissection (SCAD) is an acute coronary event of uncertain origin. Clinical features and prognosis remain insufficiently characterized.

Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is underdiagnosed and an important cause of myocardial infarction in young women. The frequency of predisposing and precipitating conditions and cardiovascular outcomes remains poorly described.

Spontaneous coronary artery dissection (SCAD) is under-diagnosed and the true prevalence is underestimated. Unfortunately, SCAD is frequently missed on coronary angiogram since the arterial wall is not imaged with this test. Optical coherence tomography or intravascular ultrasound should be the true gold-standard to diagnose SCAD. Given the elusive angiographic diagnosis of SCAD and the lack of familiarity with angiographic variants of SCAD, a diagnostic algorithm and angiographic classification for SCAD is proposed in this article.