urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/2071-5943-2022-21-5-102-115urmj-1091Research ArticleКАРДИОЛОГИЯCARDIOLOGYИнвазивное и консервативное лечение спонтанной диссекции коронарных артерий: метаанализInvasive and conservative treatment of spontaneous coronary artery dissection: a meta-analysishttps://orcid.org/0000-0002-2847-4422БродовскаяТ. О.BrodovskajaT. O.

Татьяна Олеговна Бродовская, доктор медицинских наук

Екатеринбург

Tat'jana O. Brodovskaja, Doctor of Science (Medicine)

Ekaterinburg

tbrod80@gmail.comСаидС.SaeedS.

Саид Сахрай, доктор медицинских наук

Bergen

Saeed Sahraj, Doctor of Science (Medicine), PhD

Bergen

БабыкинаЕ. Г.BabykinaE. G.

Евгения Георгиевна Бабыкина, профессор математики

Lille

Evgenija G. Babykina, mathematics professor, PhD

Lille

https://orcid.org/0000-0002-6023-3434ПотоцкийС. В.PotockijS. V.

Станислав Владимирович Потоцкий, врач

Верхняя Пышма, Свердловская область

Stanislav V. Potockij, Physician

Verkhnyaya Pyshma, Sverdlovsk Region

https://orcid.org/0000-0002-5136-4387ТкачукМ. М.TkachukM. M.

Мария Михайловна Ткачук, студентка

Екатеринбург

Marija M. Tkachuk, Student

Ekaterinburg

https://orcid.org/0000-0001-8846-7825ИсмаиловаМ. С.IsmailovaM. S.

Медине Серверовна Исмаилова, студентка

Екатеринбург

Medine S. Ismailova, Student

Ekaterinburg

https://orcid.org/0000-0002-9004-3711ГришинаИ. Ф.GrishinaI. F.

Ирина Федоровна Гришина, доктор медицинских наук, профессор

Екатеринбург

Irina F. Grishina, Doctor of Science (Medicine), Professor

Ekaterinburg

Grishina@edc.nexcom.ruПеретолчинаТ. Ф.PeretolchinaT. F.

Татьяна Федоровна Перетолчина, доктор медицинских наук, профессор

Екатеринбург

Tat'jana F. Peretolchina, Doctor of Science (Medicine), Professor

Ekaterinburg

https://orcid.org/0000-0002-7840-1387БородулинаТ. В.BorodulinaT. V.

Татьяна Викторовна Бородулина, доктор медицинских наук, доцент

Екатеринбург

Tat'jana V. Borodulina, Doctor of Science (Medicine), Associate Professor

Ekaterinburg

Уральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationHaukeland University HospitalНорвегияHaukeland University HospitalNorwayUniversitede LilleФранцияUniversitede LilleFranceВерхнепышминская центральная городская больница имени П. Д. БородинаРоссияP.D. Borodin Central City HospitalRussian Federation202205112022215102115Copyright © Бродовская Т.О., Саид С., Бабыкина Е.Г., Потоцкий С.В., Ткачук М.М., Исмаилова М.С., Гришина И.Ф., Перетолчина Т.Ф., Бородулина Т.В., 20222022Бродовская Т.О., Саид С., Бабыкина Е.Г., Потоцкий С.В., Ткачук М.М., Исмаилова М.С., Гришина И.Ф., Перетолчина Т.Ф., Бородулина Т.В.Brodovskaja T.O., Saeed S., Babykina E.G., Potockij S.V., Tkachuk M.M., Ismailova M.S., Grishina I.F., Peretolchina T.F., Borodulina T.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1091

Цель работы – сравнить эффективность и безопасность консервативной и инвазивной стратегий лечения у пациентов со спонтанной диссекцией коронарных артерий (СДКА). Материалы и методы. Проведен поиск в базах данных PubMed, Google Scholar, Web of Science с 1994 по 2021 г. для исследований, в которых оценивались результаты проведения консервативной и интервенционной стратегии у пациентов с СДКА. Для поиска статей использовалась стратегия PICO: пациент, вмешательство, сравнение, исходы. Результаты и обсуждение. Всего в метаанализ было отобрано 25 исследований (n = 2577 пациентов). Средний возраст обследованных составлял 49,2 года, 1985 (77,0 %) участников метаанализа представлены пациентами женского пола. Первоначальная консервативная стратегия была избрана в 1593 (61,8 %) случаев. Средняя продолжительность наблюдений составляла 24,8 месяца. Установлено преимущество медикаментозной терапии при оценке общей летальности (OR 0,48; CI 0,27–0,86, p = 0,01) и частоте реваскуляризации (OR 0,43; 95 % CI 0,22–0,81, p = 0.01). Анализ частоты инфаркта миокарда (ИМ) (OR 1,05; 95 % CI 0,66–1,66, p = 0,85) и возвратной СДКА (OR 1,1; 95 % CI 0,7–1,72, p = 0,69) не выявил различий. Заключение. Первоначальная консервативная стратегия терапии СДКА превосходит результаты хирургического лечения с позиций общей летальности и связана со значительно более низкой частотой повторной реваскуляризации. В то же время обе стратегии демонстрируют сопоставимые риски развития осложнений, таких как ИМ, рецидив СДКА. Необходимы дальнейшие исследования для уточнения наилучшего терапевтического подхода к пациентам с СДКА.

Background. This study aims to compare clinical outcomes of SCAD patients initially managed with medical therapy (conservative approach) versus intervention strategy. Materials and methods. We identified relevant studies by performing a systematic search in the PubMed, Google Scholar, Web of Science databases available from 1994 until 2021. The search was conducted using PICO tool (Patient, Intervention, Comparison, Outcome). Results and Discussion. 25 studies involving 2577 patients with SCAD were included. Mean age of patients was 49,2 years, 1985 (77,0 %) were female. The primary conservative strategy performed in 1593 (61,8 %) cases. Mean follow-up duration was 28,5 months. The conservative therapy showed benefit when assessing the overall mortality (OR 0,48; CI 0,27–0,86, p = 0,01) and revascularization frequency (OR 0,43; 95 % CI 0,22–0,81, p = 0.01). Statistically significant differences in myocardial infarction (OR 1,05; 95 % CI 0,66–1,66, p = 0,85) or recurrent SCAD (OR 1,1; 95 % CI 0,7–1,72, p = 0,69) were not revealed. Conclusion. The primary conservative strategy of SCAD therapy is associated with lower overall mortality and further revascularization, but not MI and recurrent SCAD. Further research is needed to clarify the best therapeutic approach in patients with SCAD.

спонтанная диссекция коронарных артерийреваскуляризациялечениеspontaneous coronary artery dissection (SCAD)revascularizationtreatmentReferencesКардиология. Национальное руководство. Краткое издание / под ред. Е.В. Шляхто. М.: ГЭОТАР-Медиа; 2020. 816 с. ISBN 978-5-9704-5397-1.Кардиология. Национальное руководство. Краткое издание / под ред. Е.В. Шляхто. М.: ГЭОТАР-Медиа; 2020. 816 с. ISBN 978-5-9704-5397-1.Thygesen K., Alpert J.S., Jaffe A.S. et al. Fourth universal definition of myocardial infarction. Eur Heart J. 2019;40(3):237–269. https://doi.org/10.1093/eurheartj/ehy462.Thygesen K., Alpert J.S., Jaffe A.S. et al. Fourth universal definition of myocardial infarction. Eur Heart J. 2019;40(3):237–269. https://doi.org/10.1093/eurheartj/ehy462.Бокерия Л.А., Голухова Е.З., Петросян К.В., Караев А.В., Григорян М.Р., Лосев В.В. Спонтанная диссекция коронарных артерий: клинические случаи и литературная справка. Креативная кардиология. 2020;14(1):71–81. https://doi.org/10.24022/1997-3187-2020-14-1-71-81Бокерия Л.А., Голухова Е.З., Петросян К.В., Караев А.В., Григорян М.Р., Лосев В.В. Спонтанная диссекция коронарных артерий: клинические случаи и литературная справка. Креативная кардиология. 2020;14(1):71–81. https://doi.org/10.24022/1997-3187-2020-14-1-71-81Hayes S.N., Kim E.S., Saw J. et al. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 2018;137(19):e523–e557. https://doi.org/10.1161/CIR.0000000000000564Hayes S.N., Kim E.S., Saw J. et al. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 2018;137(19):e523–e557. https://doi.org/10.1161/CIR.0000000000000564Yip A., Saw J. Spontaneous coronary artery dissection: a review. Cardiovasc Diagn Ther. 2015;5(1):37–48. https://doi.org/10.3978/j.issn.2223-3652.2015.01.08.Yip A., Saw J. Spontaneous coronary artery dissection: a review. Cardiovasc Diagn Ther. 2015;5(1):37–48. https://doi.org/10.3978/j.issn.2223-3652.2015.01.08.Inohara T., Saw J., Kohsaka S. et al. Treatment pattern and outcome of spontaneous coronary artery dissection in Japan. Int J Cardiol. 2020;316:13–18. https://doi.org/10.1016/j.ijcard.2020.04.082.Inohara T., Saw J., Kohsaka S. et al. Treatment pattern and outcome of spontaneous coronary artery dissection in Japan. Int J Cardiol. 2020;316:13–18. https://doi.org/10.1016/j.ijcard.2020.04.082.Kotecha D., Garcia-Guimaraes M., Premawardhana D. et al. Risks and benefits of percutaneous coronary intervention in spontaneous coronary artery dissection. Heart. 2021;107(17):1398–1406. https://doi.org/10.1136/heartjnl-2020-318914.Kotecha D., Garcia-Guimaraes M., Premawardhana D. et al. Risks and benefits of percutaneous coronary intervention in spontaneous coronary artery dissection. Heart. 2021;107(17):1398–1406. https://doi.org/10.1136/heartjnl-2020-318914.Tweet M.S., Hayes S.N., Pitta S.R. et al. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012;126(5):579–588. https://doi.org/10.1161/CIRCULATIONAHA.112.105718Tweet M.S., Hayes S.N., Pitta S.R. et al. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012;126(5):579–588. https://doi.org/10.1161/CIRCULATIONAHA.112.105718Shamloo B.K., Chintala R.S., Nasur A. et al. Spontaneous coronary artery dissection: aggressive vs. conservative therapy. J Invasive Cardiol. 2010;22(5):222–228.Shamloo B.K., Chintala R.S., Nasur A. et al. Spontaneous coronary artery dissection: aggressive vs. conservative therapy. J Invasive Cardiol. 2010;22(5):222–228.Saw J., Humphries K., Aymong E. et al. Spontaneous coronary artery dissection clinical outcomes and risk of recurrence. J Am Coll Cardiol. 2017;70(9):1148–1158. https://doi.org/10.1016/j.jacc.2017.06.053.Saw J., Humphries K., Aymong E. et al. Spontaneous coronary artery dissection clinical outcomes and risk of recurrence. J Am Coll Cardiol. 2017;70(9):1148–1158. https://doi.org/10.1016/j.jacc.2017.06.053.Jorgensen M.B., Aharonian V., Mansukhani P., Mahrer P.R. Spontaneous coronary dissection: a cluster of cases with this rare finding. Am Heart J. 1994;127(5):1382–1387. https://doi.org/10.1016/0002-8703(94)90060-4.Jorgensen M.B., Aharonian V., Mansukhani P., Mahrer P.R. Spontaneous coronary dissection: a cluster of cases with this rare finding. Am Heart J. 1994;127(5):1382–1387. https://doi.org/10.1016/0002-8703(94)90060-4.Mortensen K.H., Thuesen L., Kristensen I.B., Christiansen E.H. Spontaneous coronary artery dissection: a Western Denmark Heart Registry study. Catheter Cardiovasc Interv. 2009;74(5):710–717. https://doi.org/10.1002/ccd.22115.Mortensen K.H., Thuesen L., Kristensen I.B., Christiansen E.H. Spontaneous coronary artery dissection: a Western Denmark Heart Registry study. Catheter Cardiovasc Interv. 2009;74(5):710–717. https://doi.org/10.1002/ccd.22115.Ito H., Taylor L., Bowman M. et al. Presentation and therapy of spontaneous coronary artery dissection and comparisons of postpartum versus nonpostpartum cases. Am J Cardiol. 2011;107(11):1590–1596. https://doi.org/10.1016/j.amjcard.2011.01.043Ito H., Taylor L., Bowman M. et al. Presentation and therapy of spontaneous coronary artery dissection and comparisons of postpartum versus nonpostpartum cases. Am J Cardiol. 2011;107(11):1590–1596. https://doi.org/10.1016/j.amjcard.2011.01.043Alfonso F., Paulo M., Lennie V. et al. Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a “conservative” therapeutic strategy. JACC Cardiovasc Interv. 2012;5(10):1062–1070. https://doi.org/10.1016/j.jcin.2012.06.014.Alfonso F., Paulo M., Lennie V. et al. Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a “conservative” therapeutic strategy. JACC Cardiovasc Interv. 2012;5(10):1062–1070. https://doi.org/10.1016/j.jcin.2012.06.014.Alfonso F., Paulo M., Gonzalo N. et al. Diagnosis of spontaneous coronary artery dissection by optical coherence tomography. J Am Coll Cardiol. 2012;59(12):1073–1079. https://doi.org/10.1016/j.jacc.2011.08.082.Alfonso F., Paulo M., Gonzalo N. et al. Diagnosis of spontaneous coronary artery dissection by optical coherence tomography. J Am Coll Cardiol. 2012;59(12):1073–1079. https://doi.org/10.1016/j.jacc.2011.08.082.Buja P., Coccato M., Fraccaro C. et al. Management and outcome of spontaneous coronary artery dissection: Conservative therapy versus revascularization. Int J Cardiol. 2013;168(3):2907–2908. https://doi.org/10.1016/j.ijcard.2013.03.116.Buja P., Coccato M., Fraccaro C. et al. Management and outcome of spontaneous coronary artery dissection: Conservative therapy versus revascularization. Int J Cardiol. 2013;168(3):2907–2908. https://doi.org/10.1016/j.ijcard.2013.03.116.Saw J., Aymong E., Sedlak T. et al. Spontaneous coronary artery dissection association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014;7(5):645–655. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001760.Saw J., Aymong E., Sedlak T. et al. Spontaneous coronary artery dissection association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014;7(5):645–655. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001760.Tweet M.S., Eleid M.F., Best P.J. et al. Spontaneous coronary artery dissection: revascularisation versus conservative therapy. Circ Cardiovasc Interv. 2014;7(6):777–786. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001659Tweet M.S., Eleid M.F., Best P.J. et al. Spontaneous coronary artery dissection: revascularisation versus conservative therapy. Circ Cardiovasc Interv. 2014;7(6):777–786. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001659Lettieri C., Zavalloni D., Rossini R. et al. Management and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol. 2015;116(1):66–73. https://doi.org/10.1016/j.amjcard.2015.03.039.Lettieri C., Zavalloni D., Rossini R. et al. Management and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol. 2015;116(1):66–73. https://doi.org/10.1016/j.amjcard.2015.03.039.Sultan A., Kreutz R.P. Variations in clinical presentation, risk factors, treatment and prognosis of spontaneous coronary artery dissection. J Invasive Cardiol. 2015;27(8):363–369.Sultan A., Kreutz R.P. Variations in clinical presentation, risk factors, treatment and prognosis of spontaneous coronary artery dissection. J Invasive Cardiol. 2015;27(8):363–369.Godinho A.R., Vasconcelos M., Ara?jo V., Maciel M.J. Spontaneous coronary artery dissection in acute coronary syndrome: report of a series of cases with 17 patients. Arq Bras Cardiol. 2016;107(5):491–494. https://doi.org/10.5935/abc.20160170.Godinho A.R., Vasconcelos M., Ara?jo V., Maciel M.J. Spontaneous coronary artery dissection in acute coronary syndrome: report of a series of cases with 17 patients. Arq Bras Cardiol. 2016;107(5):491–494. https://doi.org/10.5935/abc.20160170.McGrath-Cadell L., McKenzie P., Emmanuel S. et al. Outcomes of patients with spontaneous coronary artery dissection. Open Heart. 2016;3:e000491. https://doi.org/10.1136/openhrt-2016-000491.McGrath-Cadell L., McKenzie P., Emmanuel S. et al. Outcomes of patients with spontaneous coronary artery dissection. Open Heart. 2016;3:e000491. https://doi.org/10.1136/openhrt-2016-000491.Nakashima T., Noguchi T., Haruta S. 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;207:341–348. https://doi.org/10.1016/j.ijcard.2016.01.188.Nakashima T., Noguchi T., Haruta S. 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;207:341–348. https://doi.org/10.1016/j.ijcard.2016.01.188.Roura G., Ariza-Sol? A., Rodriguez-Caballero I.F. et al. Noninvasive follow-up of patients with spontaneous coronary artery dissection with CT angiography. JACC: Cardiovascular Imaging. 2016;9(7):896–897. https://doi.org/10.1016/j.jcmg.2015.06.011.Roura G., Ariza-Sol? A., Rodriguez-Caballero I.F. et al. Noninvasive follow-up of patients with spontaneous coronary artery dissection with CT angiography. JACC: Cardiovascular Imaging. 2016;9(7):896–897. https://doi.org/10.1016/j.jcmg.2015.06.011.Cade J.R., Szarf G., de Siqueira M.E. et al. Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients. Eur Heart J Cardiovasc Imaging. 2017;18(1):54–61. https://doi.org/10.1093/ehjci/jew021.Cade J.R., Szarf G., de Siqueira M.E. et al. Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients. Eur Heart J Cardiovasc Imaging. 2017;18(1):54–61. https://doi.org/10.1093/ehjci/jew021.Conrotto F., D'Ascenzo F., Cerrato E. et al. Safety and efficacy of drug eluting stents in patients with spontaneous coronary artery dissection. Int J Cardiol. 2017;238:105–109. https://doi.org/10.1016/j.ijcard.2017.03.027.Conrotto F., D'Ascenzo F., Cerrato E. et al. Safety and efficacy of drug eluting stents in patients with spontaneous coronary artery dissection. Int J Cardiol. 2017;238:105–109. https://doi.org/10.1016/j.ijcard.2017.03.027.Rogowsky S., Maeder M.T., Weilenmann D. et al. Spontaneous coronary artery dissection: angiographic follow-up and longterm clinical outcome in a predominantly medically treated population. Catheter Cardiovasc Interv. 2017;89(1):59–68. https://doi.org/10.1002/ccd.26383.Rogowsky S., Maeder M.T., Weilenmann D. et al. Spontaneous coronary artery dissection: angiographic follow-up and longterm clinical outcome in a predominantly medically treated population. Catheter Cardiovasc Interv. 2017;89(1):59–68. https://doi.org/10.1002/ccd.26383.Abreu G., Braga C.G., Costa J. et al. Spontaneous coronary artery dissection: A single-center case series and literature review. Rev Port Cardiol. 2018;37(8):707–713. https://doi.org/10.1016/j.repc.2017.07.019.Abreu G., Braga C.G., Costa J. et al. Spontaneous coronary artery dissection: A single-center case series and literature review. Rev Port Cardiol. 2018;37(8):707–713. https://doi.org/10.1016/j.repc.2017.07.019.Lobo A.S., Cantu S.M., Sharkey A.W. et al. Revascularization in patients with spontaneous coronary artery dissection and ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2019;74(10):1290–1300. https://doi.org/10.1016/j.jacc.2019.06.065.Lobo A.S., Cantu S.M., Sharkey A.W. et al. Revascularization in patients with spontaneous coronary artery dissection and ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2019;74(10):1290–1300. https://doi.org/10.1016/j.jacc.2019.06.065.Liu X., Xu C., Liu C., Su X. Clinical characteristics and long-term prognosis of spontaneous coronary artery dissection: A single-center Chinese experience. Pakistan Journal of Medical Sciences. 2019. 2019;35(1):106–112. https://doi.org/10.12669/pjms.35.1.321.Liu X., Xu C., Liu C., Su X. Clinical characteristics and long-term prognosis of spontaneous coronary artery dissection: A single-center Chinese experience. Pakistan Journal of Medical Sciences. 2019. 2019;35(1):106–112. https://doi.org/10.12669/pjms.35.1.321.Garc?a-Guimaraes M., Bastante T., Macaya F. et al. Spontaneous coronary artery dissection in Spain: clinical and angiographic characteristics, management, and in-hospital events. Rev Esp Cardiol (Engl Ed). 2021;74(1):15–23. https://doi.org/10.1016/j.rec.2020.04.002.Garc?a-Guimaraes M., Bastante T., Macaya F. et al. Spontaneous coronary artery dissection in Spain: clinical and angiographic characteristics, management, and in-hospital events. Rev Esp Cardiol (Engl Ed). 2021;74(1):15–23. https://doi.org/10.1016/j.rec.2020.04.002.Daoulah A., Al-Faifi S.M., Alhamid S. et al. Spontaneous coronary artery dissection in the gulf: G-SCAD registry. Angiology. 2021;72(1):32–43. https://doi.org/10.1177/0003319720946974.Daoulah A., Al-Faifi S.M., Alhamid S. et al. Spontaneous coronary artery dissection in the gulf: G-SCAD registry. Angiology. 2021;72(1):32–43. https://doi.org/10.1177/0003319720946974.McAlister C.P., Yi M., Adamson P.D. et al. Trends in the detection, management and 30-day outcomes of spontaneous coronary artery dissection: a six-year, New Zealand Centre experience. Heart Lung Circ. 2021;30(1):78–85. https://doi.org/10.1016/j.hlc.2020.06.020McAlister C.P., Yi M., Adamson P.D. et al. Trends in the detection, management and 30-day outcomes of spontaneous coronary artery dissection: a six-year, New Zealand Centre experience. Heart Lung Circ. 2021;30(1):78–85. https://doi.org/10.1016/j.hlc.2020.06.020Kim E.S. Spontaneous coronary-artery dissection. N Engl J Med. 2020;383(24):2358–2370. https://doi.org/10.1056/NEJMra2001524.Kim E.S. Spontaneous coronary-artery dissection. N Engl J Med. 2020;383(24):2358–2370. https://doi.org/10.1056/NEJMra2001524.Hassan S., Prakash R., Starovoytov A., Saw J. Natural history of spontaneous coronary artery dissection with spontaneous angiographic healing. JACC Cardiovasc Interv. 2019;12(6):518–527. https://doi.org/10.1016/j.jcin.2018.12.011.Hassan S., Prakash R., Starovoytov A., Saw J. Natural history of spontaneous coronary artery dissection with spontaneous angiographic healing. JACC Cardiovasc Interv. 2019;12(6):518–527. https://doi.org/10.1016/j.jcin.2018.12.011.Adlam D., Alfonso F., Maas A., Vrints C. European Society of Cardiology, Acute Cardiovascular Care Association, SCAD Study Group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018;39(36):3353–3368. https://doi.org/10.1093/eurheartj/ehy080.Adlam D., Alfonso F., Maas A., Vrints C. European Society of Cardiology, Acute Cardiovascular Care Association, SCAD Study Group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018;39(36):3353–3368. https://doi.org/10.1093/eurheartj/ehy080.Bocchino P.P., Angelini F., Franchin L. et al. Invasive versus conservative management in spontaneous coronary artery dissection: A meta-analysis and meta-regression study. Hellenic J Cardiol. 2021:62(4):297–303. https://doi.org/10.1016/j.hjc.2021.02.013.Bocchino P.P., Angelini F., Franchin L. et al. Invasive versus conservative management in spontaneous coronary artery dissection: A meta-analysis and meta-regression study. Hellenic J Cardiol. 2021:62(4):297–303. https://doi.org/10.1016/j.hjc.2021.02.013.Jamil A., Tajrishi F.Z., Kahe F. et al. Spontaneous coronary artery dissection managed with a conservative or revascularization approach: a meta-analysis. J Cardiovasc Med (Hagerstown). 2020;21(1):42–50. https://doi.org/10.2459/JCM.0000000000000891.Jamil A., Tajrishi F.Z., Kahe F. et al. Spontaneous coronary artery dissection managed with a conservative or revascularization approach: a meta-analysis. J Cardiovasc Med (Hagerstown). 2020;21(1):42–50. https://doi.org/10.2459/JCM.0000000000000891.Martins J.L., Afreixo V., Santos L., et al. Medical treatment or revascularisation as the best approach for spontaneous coronary artery dissection: A systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 2018;7(7):614–623. https://doi.org/10.1177/2048872617706502Martins J.L., Afreixo V., Santos L., et al. Medical treatment or revascularisation as the best approach for spontaneous coronary artery dissection: A systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 2018;7(7):614–623. https://doi.org/10.1177/2048872617706502Vanzetto G., Berger-Coz E., Barone-Rochette G. 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):250–254. https://doi.org/10.1016/j.ejcts.2008.10.023.Vanzetto G., Berger-Coz E., Barone-Rochette G. 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):250–254. https://doi.org/10.1016/j.ejcts.2008.10.023.Clare R., Duan L., Phan D. et al. Characteristics and Clinical Outcomes of Patients With Spontaneous Coronary Artery Dissection. J Am Heart Assoc. 2019;8(10):e012570. https://doi.org/10.1161/JAHA.119.012570.Clare R., Duan L., Phan D. et al. Characteristics and Clinical Outcomes of Patients With Spontaneous Coronary Artery Dissection. J Am Heart Assoc. 2019;8(10):e012570. https://doi.org/10.1161/JAHA.119.012570.Eleid M.F., Guddeti R.R., Tweet M.S. et al. Coronary artery tortuosity in spontaneous coronary artery dissection: angiographic characteristics and clinical implications. Circ Cardiovasc Interv. 2014;7(5):656–662. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001676.Eleid M.F., Guddeti R.R., Tweet M.S. et al. Coronary artery tortuosity in spontaneous coronary artery dissection: angiographic characteristics and clinical implications. Circ Cardiovasc Interv. 2014;7(5):656–662. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001676.Chou A.Y., Prakash R., Rajala J. 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):554–560. https://doi.org/10.1016/j.cjca.2016.01.009.Chou A.Y., Prakash R., Rajala J. 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):554–560. https://doi.org/10.1016/j.cjca.2016.01.009.Tweet M.S., Hayes S.N., Gulati R. et al. Pregnancy after spontaneous coronary artery dissection: a case series. Ann Intern Med. 2015;162(8):598–600. https://doi.org/10.7326/L14-0446.Tweet M.S., Hayes S.N., Gulati R. et al. Pregnancy after spontaneous coronary artery dissection: a case series. Ann Intern Med. 2015;162(8):598–600. https://doi.org/10.7326/L14-0446.Lempereur M., Fung A., Saw J. Stent mal-apposition with resorption of intramural hematoma with spontaneous coronary artery dissection. Cardiovasc Diagn Ther. 2015;5(4):323–329. https://doi.org/10.3978/j.issn.2223-3652.2015.04.05.Lempereur M., Fung A., Saw J. Stent mal-apposition with resorption of intramural hematoma with spontaneous coronary artery dissection. Cardiovasc Diagn Ther. 2015;5(4):323–329. https://doi.org/10.3978/j.issn.2223-3652.2015.04.05.Prakash R., Starovoytov A., Heydari M. et al. Catheter-Induced iatrogenic coronary artery dissection in patients with spontaneous coronary artery dissection. JACC Cardiovasc Interv. 2016;9(17):1851–1853. https://doi.org/10.1016/j.jcin.2016.06.026.Prakash R., Starovoytov A., Heydari M. et al. Catheter-Induced iatrogenic coronary artery dissection in patients with spontaneous coronary artery dissection. JACC Cardiovasc Interv. 2016;9(17):1851–1853. https://doi.org/10.1016/j.jcin.2016.06.026.Jacobs J.P., Shahian D.M., D'Agostino R.S. et al. The Society of Thoracic Surgeons National Database 2018 annual report. Ann Thorac Surg. 2018;106(6):1603–1611. https://doi.org/10.1016/j.athoracsur.2018.10.001.Jacobs J.P., Shahian D.M., D'Agostino R.S. et al. The Society of Thoracic Surgeons National Database 2018 annual report. Ann Thorac Surg. 2018;106(6):1603–1611. https://doi.org/10.1016/j.athoracsur.2018.10.001.Masoudi F.A., Ponirakis A., de Lemos J.A. et al. Trends in U.S. cardiovascular care: 2016 report from 4 ACC National Cardiovascular Data Registries. J Am Coll. Cardiol. 2017;69(11):1427–1450. https://doi.org/10.1016/j.jacc.2016.12.005.Masoudi F.A., Ponirakis A., de Lemos J.A. et al. Trends in U.S. cardiovascular care: 2016 report from 4 ACC National Cardiovascular Data Registries. J Am Coll. Cardiol. 2017;69(11):1427–1450. https://doi.org/10.1016/j.jacc.2016.12.005.Kohsaka S., Kimura T., Goto M. et al. Difference in patient profiles and outcomes in Japanese versus American patients undergoing coronary revascularization (collaborative study by CREDO-Kyoto and the Texas Heart Institute Research Database). Am J Cardiol. 2010;105(12):1698–1704. https://doi.org/10.1016/j.amjcard.2010.01.349.Kohsaka S., Kimura T., Goto M. et al. Difference in patient profiles and outcomes in Japanese versus American patients undergoing coronary revascularization (collaborative study by CREDO-Kyoto and the Texas Heart Institute Research Database). Am J Cardiol. 2010;105(12):1698–1704. https://doi.org/10.1016/j.amjcard.2010.01.349.Nishiguchi T., Tanaka A., Ozaki Y. et al. Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2016;5(3):263–270. https://doi.org/10.1177/2048872613504310.Nishiguchi T., Tanaka A., Ozaki Y. et al. Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2016;5(3):263–270. https://doi.org/10.1177/2048872613504310.Pepe M., Cecere A., Napodano M. et al. How to approach a spontaneous coronary artery dissection: An up-to-date. Interventional Cardiology Journal. 2017;3(1). Available from: https://doi.org/10.21767/2471-8157.100043.Pepe M., Cecere A., Napodano M. et al. How to approach a spontaneous coronary artery dissection: An up-to-date. Interventional Cardiology Journal. 2017;3(1). Available from: https://doi.org/10.21767/2471-8157.100043.Tweet M.S., Young K.A., Best P.J. et al. Association of pregnancy with recurrence of spontaneous coronary artery dissection among women with prior coronary artery dissection. JAMA Netw Open. 2020;3(9):e2018170. https://doi.org/10.1001/jamanetworkopen.2020.18170.Tweet M.S., Young K.A., Best P.J. et al. Association of pregnancy with recurrence of spontaneous coronary artery dissection among women with prior coronary artery dissection. JAMA Netw Open. 2020;3(9):e2018170. https://doi.org/10.1001/jamanetworkopen.2020.18170.Krittanawong C., Kumar A., Wang Z. et al. Clinical features and prognosis of patients with spontaneous coronary artery dissection. Int J Cardiol. 2020;312:33–36. https://doi.org/10.1016/j.ijcard.2020.03.044.Krittanawong C., Kumar A., Wang Z. et al. Clinical features and prognosis of patients with spontaneous coronary artery dissection. Int J Cardiol. 2020;312:33–36. https://doi.org/10.1016/j.ijcard.2020.03.044.Saw J., Starovoytov A., Humphries K. et al. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. Eur Heart J. 2019; 40 (15) :1188–1197. https://doi.org/10.1093/eurheartj/ehz007.Saw J., Starovoytov A., Humphries K. et al. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. Eur Heart J. 2019; 40 (15) :1188–1197. https://doi.org/10.1093/eurheartj/ehz007.

The authors declare that there are no conflicts of interest present.