Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2026
Impact of a multidisciplinary clinical pathway on the management of spontaneous coronary artery dissection.
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Al-Gully Jin, Forouzanfar Jessica P, Montero-Cabezas Jose M, Eikenboom Jeroen, den Exter Paul L, Ter Haar Sophie, Scheenstra Bart, den Haan Melina C, van der Kley Frank, Wouter Jukema J, Bingen Brian O, Al Amri Ibtihal
Аннотация
AIM: To evaluate the clinical impact of a dedicated multidisciplinary spontaneous coronary artery dissection (SCAD) care pathway compared with standard acute coronary syndrome management, focusing on safety, treatment patterns, clinical outcomes, and recurrence rates in patients with SCAD.
METHODS: In this retrospective observational cohort study, 117 SCAD patients were included: 63 managed within a SCAD-specific care pathway and 54 receiving standard care prior to or independent of its implementation. The SCAD pathway included protocolized angiographic diagnosis, conservative management when feasible, individualized medical therapy, screening for fibromuscular dysplasia (FMD) and systemic disorders, and SCAD-specific rehabilitation with structured follow-up. The primary endpoint was major adverse cardiovascular events (MACE) at 1‑year follow-up.
RESULTS: Patients in the SCAD pathway group were more often managed conservatively in the acute setting (76% vs. 24%, p < 0.001), had significantly lower rates of stent implantation (8% vs. 65%, p < 0.001), and were less frequently prescribed dual antiplatelet therapy (19% vs. 96%, p < 0.001). At 12-month follow-up, beta-blocker adherence was higher (76% vs. 41%, p < 0.001), aspirin use was lower (38% vs. 59%, p < 0.001), and recurrent SCAD occurred numerically less often but not statistically significantly (3% vs. 9%, p = 0.231). MACE rates were similar between groups, and no deaths occurred. FMD screening was more common in the pathway group (92% vs. 17%, p < 0.001), facilitating diagnosis and tailored long-term therapy.
CONCLUSION: Implementation of a standardized SCAD care pathway was associated with a safe conservative approach, more targeted secondary prevention, improved beta-blocker adherence, and a trend toward fewer recurrent SCAD events. These findings support integration of SCAD-specific multidisciplinary care into routine clinical practice to improve diagnostic precision and long-term outcomes.
METHODS: In this retrospective observational cohort study, 117 SCAD patients were included: 63 managed within a SCAD-specific care pathway and 54 receiving standard care prior to or independent of its implementation. The SCAD pathway included protocolized angiographic diagnosis, conservative management when feasible, individualized medical therapy, screening for fibromuscular dysplasia (FMD) and systemic disorders, and SCAD-specific rehabilitation with structured follow-up. The primary endpoint was major adverse cardiovascular events (MACE) at 1‑year follow-up.
RESULTS: Patients in the SCAD pathway group were more often managed conservatively in the acute setting (76% vs. 24%, p < 0.001), had significantly lower rates of stent implantation (8% vs. 65%, p < 0.001), and were less frequently prescribed dual antiplatelet therapy (19% vs. 96%, p < 0.001). At 12-month follow-up, beta-blocker adherence was higher (76% vs. 41%, p < 0.001), aspirin use was lower (38% vs. 59%, p < 0.001), and recurrent SCAD occurred numerically less often but not statistically significantly (3% vs. 9%, p = 0.231). MACE rates were similar between groups, and no deaths occurred. FMD screening was more common in the pathway group (92% vs. 17%, p < 0.001), facilitating diagnosis and tailored long-term therapy.
CONCLUSION: Implementation of a standardized SCAD care pathway was associated with a safe conservative approach, more targeted secondary prevention, improved beta-blocker adherence, and a trend toward fewer recurrent SCAD events. These findings support integration of SCAD-specific multidisciplinary care into routine clinical practice to improve diagnostic precision and long-term outcomes.