Ischemic heart disease, particularly acute myocardial infarction, remains one of the leading causes of morbidity and mortality worldwide. Although atherosclerosis is the most common underlying etiology, other less prevalent conditions may also trigger acute coronary syndrome (ACS). Among these, spontaneous coronary artery dissection (SCAD) represents a significant cause, especially in certain patient populations. (1)

Although coronary angiography remains the gold standard diagnostic method, the development and increasing availability of intracoronary imaging techniques, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), have significantly improved diagnostic accuracy and enabled more appropriate treatment guidance. (2) However, given that these intracoronary imaging techniques are not always available or routinely used, SCAD remains a potentially underdiagnosed condition, with heterogeneous epidemiological registries. (3)

In our country, multicenter registries allowing adequate characterization of this condition have not been available to date, and the national literature mainly consists of isolated clinical case reports. (4) In this context, the registry published by Rodríguez Arias et al. represents a particularly relevant initiative, as it constitutes the first multicenter registry including both public and private centers. (5)

Consistent with international registries, this cohort shows a higher frequency of SCAD in young women, generally with few or no traditional cardiovascular risk factors. Likewise, the most common clinical presentation was non-ST-segment elevation acute coronary syndrome (NSTE-ACS), with the left anterior descending artery being the most frequently affected vessel.

Regarding treatment, the available evidence suggests that the therapeutic approach should be customized according to the patient's clinical presentation and coronary anatomy. A conservative approach is generally recommended, with revascularization reserved for specific situations such as persistent ischemia, hemodynamic instability, malignant ventricular arrhythmias, or involvement of the left main coronary artery (LMCA). In these scenarios, percutaneous coronary intervention is the primary revascularization approach, whereas coronary artery bypass grafting is reserved for specific cases such as LMCA dissection or extensive multivessel disease. Consistent with these recommendations, most cases derived from the registry were managed conservatively, with percutaneous coronary intervention involving stent implantation being performed in 46.1% of cases.

Although this registry includes a limited number of patients, its findings are consistent with international reports and represent a starting point for further advancing the understanding of this condition in our setting. Several clinical questions remain, particularly regarding the optimal duration of dual antiplatelet therapy, the potential role of anticoagulation, the indications for statin therapy and their therapeutic targets, as well as the strategies for clinical and imaging follow-up and the recommendations regarding physical activity.

In conclusion, this study is a valuable initiative for clinical and interventional cardiology in our country, as it not only allows our experience to be contextualized in relation to international registries but also represents an important step in further characterizing an uncommon but clinically relevant condition.