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SCAD Long-term Management — EECC MCQ

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ModerateCoronary Artery DiseaseSCAD Long-term ManagementEECC

A 45-year-old woman with SCAD (spontaneous coronary artery dissection) of the mid-LAD is managed conservatively. At 6-month follow-up, repeat angiography shows complete healing of the dissection. She asks about long-term recurrence risk. What should she be told?

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Correct answer: D — SCAD recurrence affects approximately 10-30% of patients over 10 years; lifelong cardiovascular follow-up and avoidance of extreme physical exertion and hormonal triggers are recommended

SCAD has a significant long-term recurrence rate of approximately 10-30% over 5-10 years, typically affecting a different coronary artery than the index event. The 2023 ESC ACS Guidelines recommend: (1) conservative management as default for SCAD (PCI/CABG only for ongoing ischaemia or haemodynamic instability); (2) lifelong follow-up with CCTA or invasive angiography if symptoms recur; (3) screening for associated conditions (fibromuscular dysplasia in 50-70% of cases, other arteriopathies); (4) avoidance of extreme physical exertion (e.g. competitive sport, heavy isometric exercise) and hormonal triggers (pregnancy carries high recurrence risk). Dual antiplatelet therapy is not clearly beneficial long-term.

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes; EuroPCR SCAD Consensus