Spontaneous Coronary Artery Dissection (SCAD): Unveiling the Enigma of the Unexpected Coronary Event.

PURPOSE OF REVIEW: Spontaneous coronary artery dissection (SCAD) is an underrecognized cause of acute coronary syndrome, primarily affecting younger women without traditional risk factors. This review synthesizes current knowledge, identifies research gaps, and explores how precision medicine can improve diagnosis, treatment, and patient outcomes. RECENT FINDINGS: SCAD is clinically and biologically heterogeneous, with variation in presentation, etiology, and recurrence risk. Contributing factors include sex-specific hormonal differences, vascular abnormalities, genetic predisposition, psychosocial stressors, and social determinants of health. Despite growing awareness, major gaps persist in risk stratification and tailored care. Emerging tools, including genomics, radiomics, and multiomics, offer opportunities to define SCAD subtypes and personalized management. A precision medicine framework integrating molecular, imaging, and social data may transform SCAD care. Continued research is essential to improve early detection, optimize therapy, and reduce recurrence.