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Abstract

Spontaneous coronary artery dissection (SCAD) is a rare, but increasingly recognized cause of acute coronary syndrome (ACS). While previously only described in case series, the advent of advanced imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) has increased its prevalence dramatically. Anatomically, SCAD results from the formation of an intramural hematoma with or without intimal tear in a coronary artery, potentially leading to occlusion and ischemia. This phenomenon is especially common in women, accounting for 35% of ACS in women under the age of 50, and representing the leading cause of peripartum myocardial infarct.1 There is a lack of consensus on whether to opt for a conservative approach or revascularization for these patients, but several small retrospective studies exist that compare the effect these management strategies have on cardiac outcomes. Consequently, treatment is usually chosen on a case basis rather than using a standard approach.2 Conservative therapy is purely medical and typical ly includes antiplatelet therapy, beta-blockade, and antihypertensives, but optimal medical therapy is not well defined.3 Revascularization options include percutaneous intervention (PCI) and coronary artery bypass grafting (CABG). The aim of this qualitative systematic review is to identify the literature involving the difference in cardiac outcomes (death, recurrent SCD, congestive heart failure, ACS) after conservative therapy versus revascularization in management of SCAD, analyze how these studies made their conclusions, and summarize the risk factors that the treatment team used to determine management strategy.

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