Coronary artery dissection becomes a high-urgency presentation when it involves the left main coronary artery, extends to two proximal coronary vessels, occurs alongside active myocardial ischemia, or is accompanied by haemodynamic instability. In these circumstances, conservative management alone is not considered appropriate.
High-risk anatomy — dissection of the left main or two proximal coronary arteries, ongoing ischaemia, or haemodynamic compromise — places this presentation in a category where expedited intervention, rather than watchful waiting, is the guiding principle.
The primary clinical objective is relief of myocardial ischaemia. When these high-risk features are present, urgent revascularisation is central to the approach — the specific method and any subsequent management are determined by the individual's coronary anatomy and the available clinical expertise. The complete, stepwise regimen is behind the link below.
Goal: Relief of myocardial ischaemiaDOI: 10.1161/cir.0000000000000564
Conservative therapy may not be appropriate in high-risk patients with ongoing ischemia, left main artery dissection, or hemodynamic instability.
High-risk anatomy indicates SCAD affecting the left main or 2 proximal coronary arteries.
In such cases, it is the consensus of the working group that urgent intervention with PCI or coronary artery bypass grafting (CABG) should be considered, but such decisions should be individualized and contemplated in the context of the coronary anatomy and the expertise of the operators or centers.
View source ↗