The new European Society of Cardiology (ESC) 2020 Acute Coronary Syndromes (ACS) Clinical Practice Guidelines have been published and we are very pleased that SCAD has a section for the first time.
These guidelines are for the management of ACS in patients presenting without persistent ST-segment elevation.
Key points are that:
- SCAD accounts for up to 4% of all ACS
- but the incidence is reported to be much higher (22-35% of ACS) in women under 60 years old, in pregnancy-related heart attacks, and in patients with a history of fibromuscular dysplasia (FMD), anxiety or depression.
The guidelines say that as SCAD may be missed or not be detectable using coronary computed tomography angiography (CCTA), intracoronary imaging, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS) may be more accurate options for diagnosis.
Conservative management is preferred, except for high-risk patients, but the optimal treatment is unclear as there have been no randomised clinical trials.
The statistics reported in the guidelines support our view that the diagnosis of SCAD and the treatment and support of SCAD patients should be included in Government strategies for heart disease. To achieve that Beat SCAD has been involved in consultations both in Scotland in collaboration with the BHF Scotland, and as a stakeholder organisation for the new NICE. guidelines on ACS, which is due for publication on 18 November.