{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:08:52Z","timestamp":1779890932709,"version":"3.53.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neth Heart J"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the clinical impact of a\u00a0dedicated multidisciplinary spontaneous coronary artery dissection (SCAD) care pathway compared with standard acute coronary syndrome management, focusing on safety, treatment patterns, clinical outcomes, and recurrence rates in patients with SCAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective observational cohort study, 117 SCAD patients were included: 63\u00a0managed within a\u00a0SCAD-specific care pathway and 54\u00a0receiving standard care prior to or independent of its implementation. The SCAD pathway included protocolized angiographic diagnosis, conservative management when feasible, individualized medical therapy, screening for fibromuscular dysplasia (FMD) and systemic disorders, and SCAD-specific rehabilitation with structured follow-up. The primary endpoint was major adverse cardiovascular events (MACE) at 1\u2011year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients in the SCAD pathway group were more often managed conservatively in the acute setting (76% vs.\u00a024%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.001), had significantly lower rates of stent implantation (8% vs.\u00a065%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.001), and were less frequently prescribed dual antiplatelet therapy (19% vs.\u00a096%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.001). At 12-month follow-up, beta-blocker adherence was higher (76% vs.\u00a041%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.001), aspirin use was lower (38% vs.\u00a059%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.001), and recurrent SCAD occurred numerically less often but not statistically significantly (3% vs.\u00a09%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.231). MACE rates were similar between groups, and no deaths occurred. FMD screening was more common in the pathway group (92% vs.\u00a017%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.001), facilitating diagnosis and tailored long-term therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Implementation of a\u00a0standardized SCAD care pathway was associated with a\u00a0safe conservative approach, more targeted secondary prevention, improved beta-blocker adherence, and a\u00a0trend toward fewer recurrent SCAD events. These findings support integration of SCAD-specific multidisciplinary care into routine clinical practice to improve diagnostic precision and long-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12471-026-02050-w","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:02:59Z","timestamp":1779062579000},"page":"225-235","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of a\u00a0multidisciplinary clinical pathway on the management of spontaneous coronary artery dissection"],"prefix":"10.1007","volume":"34","author":[{"given":"Jin","family":"Al-Gully","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica P.","family":"Forouzanfar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M.","family":"Montero-Cabezas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"Eikenboom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L.","family":"den Exter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"ter Haar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Scheenstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melina C.","family":"den Haan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"van der Kley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Wouter Jukema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian O.","family":"Bingen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibtihal","family":"Al Amri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"issue":"6","key":"2050_CR1","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1016\/j.jcin.2018.12.011","volume":"12","author":"S Hassan","year":"2019","unstructured":"Hassan S, Prakash R, Starovoytov A, Saw J. Natural History of Spontaneous Coronary Artery Dissection With Spontaneous Angiographic Healing. JACC Cardiovasc Interv. 2019;12(6):518\u201327.","journal-title":"JACC Cardiovasc Interv"},{"key":"2050_CR2","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.amjcard.2025.08.017","volume":"255","author":"J Al-Gully","year":"2025","unstructured":"Al-Gully J, Montero-Cabezas JM, Eikenboom J, et al. Diagnosis and Treatment of Unrecognized Spontaneous Coronary Artery Dissection in Young Women Presenting with an Acute Coronary Syndrome. Am J Cardiol. 2025;255:116\u201325.","journal-title":"Am J Cardiol"},{"issue":"33","key":"2050_CR3","doi-asserted-by":"publisher","first-page":"3161","DOI":"10.1093\/eurheartj\/ehab372","volume":"42","author":"E Cerrato","year":"2021","unstructured":"Cerrato E, Giacobbe F, Quadri G, et al. Antiplatelet therapy in patients with conservatively managed spontaneous coronary artery dissection from the multicentre DISCO registry. Eur Heart\u00a0J. 2021;42(33):3161\u201371.","journal-title":"Eur Heart J"},{"key":"2050_CR4","volume":"54","author":"E Christenson","year":"2024","unstructured":"Christenson E, Acharya D, Berlacher K, Koczo A. Guidance Directed Care of Spontaneous Coronary Artery Dissection: A Healthcare System-Based Experience. Int J Cardiol Heart Vasc. 2024;54:101498.","journal-title":"Int J Cardiol Heart Vasc"},{"issue":"1","key":"2050_CR5","first-page":"55","volume":"13","author":"RA Byrne","year":"2024","unstructured":"Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc Care. 2024;13(1):55\u2013161.","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"issue":"1","key":"2050_CR6","first-page":"37","volume":"5","author":"A Yip","year":"2015","unstructured":"Yip A, Saw J. Spontaneous coronary artery dissection-A review. Cardiovasc Diagn Ther. 2015;5(1):37\u201348.","journal-title":"Cardiovasc Diagn Ther"},{"issue":"12","key":"2050_CR7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101385","volume":"3","author":"D Crousillat","year":"2024","unstructured":"Crousillat D, Sarma A, Wood M, et al. Spontaneous Coronary Artery Dissection: Current Knowledge, Research Gaps, and Innovative Research Initiatives: JACC Advances Expert Panel. JACC Adv. 2024;3(12)101385.","journal-title":"JACC Adv"},{"key":"2050_CR8","doi-asserted-by":"crossref","unstructured":"Liem SS, van der Hoeven BL, Oemrawsingh PV, et\u00a0al. MISSION!: optimization of acute and chronic care for patients with acute myocardial infarction. Am Heart J. 2007;153(1).","DOI":"10.1016\/j.ahj.2006.10.002"},{"issue":"9","key":"2050_CR9","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.118.006772","volume":"11","author":"TM Waterbury","year":"2018","unstructured":"Waterbury TM, Tweet MS, Hayes SN, et al. Early Natural History of Spontaneous Coronary Artery Dissection. Circ Cardiovasc Interv. 2018;11(9)e006772.","journal-title":"Circ Cardiovasc Interv"},{"issue":"1","key":"2050_CR10","doi-asserted-by":"publisher","first-page":"142","DOI":"10.21037\/cdt-20-71","volume":"11","author":"E Rayner-Hartley","year":"2021","unstructured":"Rayner-Hartley E, Verma T, Starovoytov A, Aymong E, Nicolau S, Saw J. Catheter-based angiography versus CT angiography for the diagnosis of extracoronary fibromuscular dysplasia in patients with spontaneous coronary artery dissection. Cardiovasc Diagn Ther. 2021;11(1):142\u20135.","journal-title":"Cardiovasc Diagn Ther"},{"issue":"2","key":"2050_CR11","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1177\/1358863X18821816","volume":"24","author":"HL Gornik","year":"2019","unstructured":"Gornik HL, Persu A, Adlam D, et al. First International Consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med. 2019;24(2):164\u201389.","journal-title":"Vasc Med"},{"issue":"9","key":"2050_CR12","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.1016\/j.jacc.2017.06.053","volume":"70","author":"J Saw","year":"2017","unstructured":"Saw J, Humphries K, Aymong E, et al. Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence. J\u00a0Am Coll Cardiol. 2017;70(9):1148\u201358.","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"2050_CR13","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1111\/acem.14426","volume":"29","author":"AK Johnson","year":"2022","unstructured":"Johnson AK, Tweet MS, Rouleau SG, Sadosty AT, Hayes SN, Raukar NP. The presentation of spontaneous coronary artery dissection in the emergency department: Signs and symptoms in an unsuspecting population. Acad Emerg Med. 2022;29(4):423\u20138.","journal-title":"Acad Emerg Med"},{"issue":"36","key":"2050_CR14","doi-asserted-by":"publisher","first-page":"3353","DOI":"10.1093\/eurheartj\/ehy080","volume":"39","author":"D Adlam","year":"2018","unstructured":"Adlam D, Alfonso F, Maas A, Vrints C, Writing C. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a\u00a0position paper on spontaneous coronary artery dissection. Eur Heart\u00a0J. 2018;39(36):3353\u201368.","journal-title":"Eur Heart J"},{"issue":"4","key":"2050_CR15","first-page":"554","volume":"32","author":"AY Chou","year":"2016","unstructured":"Chou AY, Prakash R, Rajala J, et al. The First Dedicated Cardiac Rehabilitation Program for Patients With Spontaneous Coronary Artery Dissection: Description and Initial Results. Can J Cardiol. 2016;32(4):554\u201360.","journal-title":"Can J Cardiol"},{"issue":"37","key":"2050_CR16","doi-asserted-by":"publisher","first-page":"3825","DOI":"10.1093\/eurheartj\/ehab307","volume":"42","author":"MS Tweet","year":"2021","unstructured":"Tweet MS, Olin JW, Bonikowske AR, Adlam D, Hayes SN. Physical activity and exercise in patients with spontaneous coronary artery dissection and fibromuscular dysplasia. Eur Heart\u00a0J. 2021;42(37):3825\u20138.","journal-title":"Eur Heart J"},{"issue":"26","key":"2050_CR17","doi-asserted-by":"publisher","first-page":"2442","DOI":"10.1093\/eurheartj\/ehac245","volume":"43","author":"GYH Lip","year":"2022","unstructured":"Lip GYH, Lane DA, Lenarczyk R, et al. Integrated care for optimizing the management of stroke and associated heart disease: a\u00a0position paper of the European Society of Cardiology Council on Stroke. Eur Heart\u00a0J. 2022;43(26):2442\u201360.","journal-title":"Eur Heart J"},{"issue":"7","key":"2050_CR18","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1161\/STR.0b013e318296aeca","volume":"44","author":"RL Sacco","year":"2013","unstructured":"Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st\u00a0century: a\u00a0statement for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke. 2013;44(7):2064\u201389.","journal-title":"Stroke"},{"issue":"1","key":"2050_CR19","first-page":"29","volume":"94","author":"DA Baran","year":"2019","unstructured":"Baran DA, Grines CL, Bailey S, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS). Catheter Cardiovasc Interv. 2019;94(1):29\u201337.","journal-title":"Catheter Cardiovasc Interv"},{"issue":"15","key":"2050_CR20","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1093\/eurheartj\/ehr204","volume":"32","author":"PG Steg","year":"2011","unstructured":"Steg PG, Huber K, Andreotti F, et al. Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart\u00a0J. 2011;32(15):1854\u201364.","journal-title":"Eur Heart J"},{"issue":"1","key":"2050_CR21","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1186\/s43044-024-00585-0","volume":"76","author":"A Pitliya","year":"2024","unstructured":"Pitliya A, Pitliya A, Vasudevan SS, et al. In-hospital and long-term clinical outcomes of spontaneous coronary artery dissection (SCAD): a meta-analysis of conservative versus revascularization approaches. Egypt Heart\u00a0J. 2024;76(1):153\u2013153.","journal-title":"Egypt Heart J"},{"issue":"19","key":"2050_CR22","doi-asserted-by":"publisher","first-page":"2345","DOI":"10.1001\/archinte.163.19.2345","volume":"163","author":"CB Granger","year":"2003","unstructured":"Granger CB, Goldberg RJ, Dabbous O, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163(19):2345\u201353.","journal-title":"Arch Intern Med"},{"issue":"3","key":"2050_CR23","doi-asserted-by":"publisher","first-page":"705","DOI":"10.21037\/cdt-24-108","volume":"15","author":"HE Park","year":"2025","unstructured":"Park HE, Cho LS, Fendrikova-Mahlay N, Chaudhury P, Cameron SJ. Evaluating the efficacy of antiplatelet therapy in spontaneous coronary artery dissection: a scoping review. Cardiovasc Diagn Ther. 2025;15(3):705\u201313.","journal-title":"Cardiovasc Diagn Ther"},{"issue":"6","key":"2050_CR24","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1161\/CIRCINTERVENTIONS.114.001659","volume":"7","author":"MS Tweet","year":"2014","unstructured":"Tweet MS, Eleid MF, Best PJ, et al. Spontaneous coronary artery dissection: revascularization versus conservative therapy. Circ Cardiovasc Interv. 2014;7(6):777\u201386.","journal-title":"Circ Cardiovasc Interv"},{"issue":"2","key":"2050_CR25","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2016-000491","volume":"3","author":"L McGrath-Cadell","year":"2016","unstructured":"McGrath-Cadell L, McKenzie P, Emmanuel S, Muller DW, Graham RM, Holloway CJ. Outcomes of patients with spontaneous coronary artery dissection. Open Heart. 2016;3(2)e000491.","journal-title":"Open Heart"}],"container-title":["Netherlands Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12471-026-02050-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12471-026-02050-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12471-026-02050-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T13:44:31Z","timestamp":1779889471000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12471-026-02050-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":25,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["2050"],"URL":"https:\/\/doi.org\/10.1007\/s12471-026-02050-w","relation":{},"ISSN":["1568-5888","1876-6250"],"issn-type":[{"value":"1568-5888","type":"print"},{"value":"1876-6250","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]},"assertion":[{"value":"23 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"I. Al Amri\/ her institution received speaker fees from Penumbra Inc. and Medtronic. JW Jukema\/his department has received research grants from and\/or was speaker (with or without lecture fees) on a.o.(CME accredited) meetings sponsored\/supported by Abbott, Amarin, Amgen, Athera, Biotronik, Boston Scientific, Dalcor, Daiichi Sankyo, Edwards Lifesciences, GE Healthcare Johnson and Johnson, Lilly, Medtronic, Merck-Schering-Plough, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi Aventis, Shockwave Medical, the Netherlands Heart Foundation, CardioVascular Research the Netherlands (CVON), the Netherlands Heart Institute and the European Community Framework KP7 Programme.\nF. van der Kley received consultancy fees from Edwards Lifesciences and Abbott Vascular.The remaining authors have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}