Acute coronary artery dissection is a rare, complex disease occurring particularly in young women without traditional cardiovascular risk factors. The pathophysiology and treatment are different from acute coronary syndrome caused by plaque rupture or erosion. Its clinical presentation may vary from unstable angina to sudden cardiac death. Hence, early detection is crucial to manage the dissection and reduce the mortality and morbidity rates. Most coronary dissections will heal spontaneously, and conservative treatment is recommended for uncomplicated cases. In the acute phase, primary percutaneous coronary intervention remains the reperfusion strategy of choice; however, in small- and medium-sized arteries with normalized blood flow, conservative treatment is beneficial. Medical therapy should be tailored to the individual depending on the underlying severity of the condition. Percutaneous coronary intervention should be performed by experienced operators, with the use of intravascular imaging, and preferably with on-site surgical back-up due to the increased risk of complications. The prognosis is favorable; however, patients have a high risk of recurrent dissections in other arteries several weeks after the first event, suggesting a general weakness of the arteries. In the recent past, optical coherence tomography has played an important role in the diagnosis of acute coronary artery dissection; however, its therapeutic potential is underestimated. We recommend that long-term clinical trials should be conducted to fully determine the long-term mortality and morbidity rates of these patients.

中文翻译：

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急性冠状动脉夹层：文献和最新证据的回顾。

急性冠状动脉夹层是一种罕见的复杂疾病，尤其是在没有传统心血管危险因素的年轻女性中。病理生理和治疗不同于由斑块破裂或糜烂引起的急性冠状动脉综合征。其临床表现可能从不稳定的心绞痛到心源性猝死不等。因此，早期发现对于处理解剖并降低死亡率和发病率至关重要。大多数冠状动脉夹层会自然愈合，对于不复杂的病例，建议保守治疗。在急性期，主要的经皮冠状动脉介入治疗仍然是首选的再灌注策略。但是，在血流量正常的中小动脉中，保守治疗是有益的。药物治疗应根据病情的潜在严重程度而定。经皮冠状动脉介入治疗应由经验丰富的操作人员进行，并使用血管内成像，并且由于并发症风险增加，最好进行现场手术支持。预后良好；然而，患者在第一次事件后数周内有发生其他动脉反复夹层的高风险，提示该动脉总体无力。近年来，光学相干断层扫描在急性冠状动脉夹层的诊断中起着重要的作用。然而，其治疗潜力被低估了。我们建议应进行长期临床试验，以全面确定这些患者的长期死亡率和发病率。