Studies carried out in Mayo Clinic's SCAD Research Program involve:
- Evaluation of medical records and imaging data
- Patient narratives
- Analysis of physical samples
- Prospective studies
- Questionnaires at study enrollment and in follow-up
These methods help the research team compile detailed assessments of participants' current mental and physical health and evaluate risk factors for recurrent SCAD.
Ongoing recruitment, data abstraction and reporting
The SCAD Research Program has been remarkably well received by both patients and physicians. In response, research activities have been accelerated to meet current demand, engaging new research personnel and collaborators at Mayo and beyond.
Collecting relevant health information from individual participants is critical to proceeding with data abstraction and analysis, and the SCAD research team continues to work with participants and their health care providers to complete each participant's medical history. Active recruitment also continues via social media, physician referrals and other methods.
The information gathered from participants' medical records and narratives is crucial to all projects in the SCAD Research Program, but is particularly important to projects focused on:
To populate the DNA and plasma biobank, the research team performs DNA exome sequencing on samples provided by patients with SCAD and one or both of their parents. Analysis of those samples is ongoing, with a long-term goal of identifying inherited and novel genetic mutations that underlie SCAD.
Evaluation of extracoronary vascular abnormalities in patients with SCAD
Physical exams and medical imaging performed for other reasons on patients cared for in the SCAD Clinic have revealed abnormalities in arteries other than the coronary arteries (extracoronary vascular abnormalities) in patients with SCAD, including:
Mayo Clinic SCAD experts therefore advise patients to undergo vascular imaging as part of their medical evaluations to identify any coinciding vascular conditions.
The SCAD research team is retrospectively and prospectively evaluating imaging performed both at Mayo Clinic and by participants' local health care providers to better understand the cause of SCAD, inform patient follow-up and determine how extracoronary vascular abnormalities affect outcomes.
Learn more about SCAD and extracoronary vascular abnormalities, such as FMD.
Coronary artery imaging evaluations
Mayo's SCAD research team has extensive experience in interpreting coronary artery imaging in patients with SCAD. Clinical findings suggest that patients with SCAD have abnormalities in underlying coronary architecture that predispose them to vessel wall dissection; these abnormalities may be similar to those found in patients with FMD.
The team is working to identify these abnormalities, as they may provide clues to underlying mechanisms and help identify those at higher risk of recurrent events.
The research team has developed a unique CT protocol to assess for FMD and other extracoronary vascular abnormalities. The protocol maximizes convenience for patients while minimizing contrast, radiation, time and cost. However, more work remains to be done to determine the best imaging modality to identify these abnormalities, balancing risks such as radiation and contrast with accuracy and cost.
Learn more about the team's work on a SCAD CT angiogram protocol.
SCAD and mental health concerns
Depression, anxiety and — in some people — post-traumatic stress disorder (PTSD) symptoms are common after a heart attack. In addition to adversely affecting patients' quality of life, these symptoms are associated with an increased risk of subsequent cardiac events.
The SCAD research team is studying whether anxiety, depression and PTSD are more common among patients with SCAD than among patients without heart disease or among those who have heart attacks due to atherosclerosis, for whom there is a much greater body of knowledge and many proven treatment options.
Learn more about post-SCAD mental health.
The future of SCAD research at Mayo Clinic
Early findings from clinical care and research have generated multiple substudies. The SCAD research team at Mayo Clinic has grown to include:
- Internal medicine and cardiology trainees
- Vascular medicine specialists
The team's early observations have raised many new questions and set the stage for numerous retrospective, prospective, clinical and genetic studies. Ongoing and future studies and projects in Mayo Clinic's SCAD Research Program may include:
- Genetic susceptibility for familial SCAD
- The merits of revascularization as a strategy for acute management of SCAD
- Improving the patient experience for SCAD diagnosis and follow-up
- Cardiovascular rehabilitation after SCAD
- Pregnancy and SCAD
- The role of noninvasive imaging in SCAD follow-up, including optimizing techniques to reduce ionizing radiation exposure
- Coronary angiographic features in patients with SCAD
- Acquired and inherited monogenetic mutations in SCAD
- Other medical conditions such as autoimmune diseases and SCAD
- Risk and prevention of recurrence in SCAD
Ultimately, the goal of Mayo's SCAD Research Program is to develop and lead prospective studies and multicenter trials to improve outcomes through better diagnostic tools, strategies for optimal treatment at the time of the initial heart attack (acute treatment), and therapies for rehabilitation and prevention.
SCAD Discoveries and Research