TY - JOUR
T1 - Spontaneous Coronary Artery Dissection
T2 - Pitfalls of Angiographic Diagnosis and an Approach to Ambiguous Cases
AU - Adlam, David
AU - Tweet, Marysia S.
AU - Gulati, Rajiv
AU - Kotecha, Deevia
AU - Rao, Praveen
AU - Moss, Alistair J.
AU - Hayes, Sharonne
N1 - Funding Information:
This SCAD research study was supported by BeatSCAD, the British Heart Foundation (PG/13/96/30608), the National Institute for Health Research rare disease translational collaboration, the Leicester NIHR Biomedical Research Centre, and SCAD Research. Dr Moss receives funding support from the British Heart Foundation (AA/18/3/34220). Dr Adlam has received research funding from Abbott Vascular for a clinical research fellow and from AstraZeneca for SCAD genetics research and unrelated research; and has undertaken consultancy with General Electric to support general research funds. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
The authors are grateful for the support of SCAD survivors, their families, and our clinical colleagues. Dr Adlam acknowledges the leadership of the European Society of Cardiology/Association for Acute Cardiovascular Care SCAD Study Group. The authors specifically acknowledge the support of Susan Milbrandt, Jenny Middleton, Jane Plume, Donna Alexander, Sue Sterland, Daniel Lawday, Tara Maitland, and Andrea Marshall for all their support for SCAD research. All images presented except Supplemental Figures 6A and 6B are from consented patients (UK SCAD study [ISRCTN42661582], UK National Research Ethics Service [14/EM/0056]) referred to a SCAD clinic with provisional diagnoses of SCAD.
Publisher Copyright:
© 2021 The Authors
PY - 2021/8/23
Y1 - 2021/8/23
N2 - Spontaneous coronary artery dissection (SCAD) is a pathophysiologically distinct cause of acute coronary syndromes (ACS). It is increasingly recognized that optimal management is different from that for atherosclerotic ACS and that a SCAD diagnosis has specific long-term prognostic and therapeutic implications. Accurate diagnosis is therefore essential to ensure the best treatment of patients. At present this relies on the recognition of typical features of SCAD identified on invasive coronary angiography. Although most SCAD can be readily distinguished angiographically from alternative causes of ACS, false positive and false negative diagnoses remain common. In particular, sometimes non-SCAD presentations, including atherothrombosis, takotsubo cardiomyopathy, coronary embolism, coronary vasospasm, contrast streaming, and myocardial infarction with nonobstructive coronary arteries, can mimic angiographic features usually associated with SCAD. The authors present the combined experience from European and US SCAD referral centers reviewing the classical angiographic appearances of SCAD, presenting potential diagnostic pitfalls and exemplars of SCAD mimickers. The authors further review the benefits and limitations of intracoronary imaging in the context of SCAD. Finally, the authors discuss the investigation of ambiguous cases and an approach to minimize misdiagnosis in difficult cases.
AB - Spontaneous coronary artery dissection (SCAD) is a pathophysiologically distinct cause of acute coronary syndromes (ACS). It is increasingly recognized that optimal management is different from that for atherosclerotic ACS and that a SCAD diagnosis has specific long-term prognostic and therapeutic implications. Accurate diagnosis is therefore essential to ensure the best treatment of patients. At present this relies on the recognition of typical features of SCAD identified on invasive coronary angiography. Although most SCAD can be readily distinguished angiographically from alternative causes of ACS, false positive and false negative diagnoses remain common. In particular, sometimes non-SCAD presentations, including atherothrombosis, takotsubo cardiomyopathy, coronary embolism, coronary vasospasm, contrast streaming, and myocardial infarction with nonobstructive coronary arteries, can mimic angiographic features usually associated with SCAD. The authors present the combined experience from European and US SCAD referral centers reviewing the classical angiographic appearances of SCAD, presenting potential diagnostic pitfalls and exemplars of SCAD mimickers. The authors further review the benefits and limitations of intracoronary imaging in the context of SCAD. Finally, the authors discuss the investigation of ambiguous cases and an approach to minimize misdiagnosis in difficult cases.
KW - angiography
KW - computed tomography
KW - differential diagnosis
KW - intravascular ultrasound
KW - optical coherence tomography
KW - spontaneous coronary artery dissection
KW - women
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U2 - 10.1016/j.jcin.2021.06.027
DO - 10.1016/j.jcin.2021.06.027
M3 - Review article
C2 - 34412792
AN - SCOPUS:85111988786
VL - 14
SP - 1743
EP - 1756
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 16
ER -