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Spontane
KoronardissektionSpontaneous Coronary
Artery Dissection (SCAD)
PD Dr. med. Micha T. MaederKardiologie Kantonsspital St. Gallen
SCAD
•Nicht-atherosklerotische Form
der KHK
• Präsentation als ACS
• Vorwiegend Frauen betroffen
• Zwei Populationen• Assoziiert mit Schwangerschaft (P-
SCAD)
• Nicht-assoziiert mit Schwangerschaft
SCAD
•Pathophysiologie
•Diagnose
•Differentialdiagnose
•Management
•Prognose
Adlam D et al. Eur Heart J 2018
Adlam D et al. Eur Heart J 2018
Adlam D et al. Eur Heart J 2018
Klinische Charakteristika
Adlam D et al. Eur Heart J 2018
Prädisposition
Adlam D et al. Eur Heart J 2018
FMD
Adlam D et al. Eur Heart J 2018
Auslöser
SCAD
•Pathophysiologie
•Diagnose
•Differentialdiagnose
•Management
•Prognose
Saw J et al. Eur Heart 2019
Klinische Präsentation
EKG
Typ 1 SCAD
Saw J. Cathet Cardiovasc Interv 2013
Typ 2 SCAD
Saw J. Cathet Cardiovasc Interv 2013
Typ 3 SCAD
Saw J. Cathet Cardiovasc Interv 2013
Saw J et al. JACC 2016
Saw J et al. Eur Heart J 2019
Elkayam&Havakuk. JACC 2018
Saw J et al. Eur Heart J 2018
Adlam D et al. Eur Heart J 2018
SCAD
•Pathophysiologie
•Diagnose
•Differentialdiagnose
•Management
•Prognose
12.02.2019
SCAD
•Pathophysiologie
•Diagnose
•Differentialdiagnose
•Management
•Prognose
Saw J et al. JACC 2017
SCAD: med. Therapie
•Duale Tc-Hemmung
•Heparin einige Tage
•Statin
•ACE-Hemmer
•Betablocker
All patients (n=64)
CABG (n=1) PCI (n=7)
Peri-
proceduraldeath (n=1)
Medical therapy (n=56)
NSTEMI, FU
angio with
SCAD of
another vessel
(n=3)
Out-of-hospital
cardiac arrest 16
days after index
event, FU angio
with persistent
dissection (n=1)
FU angio
with good
PCI result
(n=4)
No events during
long-term FU
(n=1)No events during long-
term FU (n=6)
Procedural
success
(n=6)
FU angio
with
healed
dissection
(n=31)
FU angio
with
persistent
dissection
(n=1)
No FU angio(n=2)
No FU
angio
(n=20)
No events during long-
term FU (n=52)
Rogowski&Maeder et al. Cathet Cardiovasc Interv 2017
Saw J et al. Eur Heart J 2019
Saw J et al. Circ Cardiovasc Interv 2014
Saw J et al. JACC
2017
SCAD
•Pathophysiologie
•Diagnose
•Differentialdiagnose
•Management
•Prognose
Saw J et al. Eur Heart J 2019
n=750
Tweet MS et al. Circ CV
Interv 2014
Adlam D et al. Eur Heart J 2018
Rogowski&Maeder et al. Cathet Cardiovasc Interv 2017
SCAD
•Pathophysiologie
•Diagnose
•Differentialdiagnose
•Management
•Prognose
