Recurrent Acute Coronary Syndrome in Spontaneous Coronary Artery Dissection.

BACKGROUND

Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome (ACS) in vascular Ehlers-Danlos syndrome (vEDS).

CASE SUMMARY: A 35-year-old with vEDS, found to have SCAD on coronary computed tomography angiography, was admitted with recurrent episodes of ACS. After each event, a heart team recommended medical management, eventually leading to resolution of symptoms without the need for invasive revascularization. WHY BEYOND THE GUIDELINES?: There are few guidelines for the management of recurrent ACS in the setting of SCAD, and clinicians are left without concrete recommendations for these high-risk clinical scenarios.

DISCUSSION: ACS management in vEDS-associated SCAD is made challenging by limited evidence to guide risk stratification, and it remains difficult to identify patients who will require revascularization vs those who can be medically managed.

TAKE-HOME MESSAGE: In the absence of evidence-based guidelines, SCAD management should be guided by a heart team approach.