Abstract
Spontaneous coronary artery dissection (SCAD) is a rare condition that may have a serious outcome because of acute coronary syndrome. The condition especially affects young women. We evaluated a middle-aged male patient with a non-ST segment elevation myocardial infarction caused by multivessel SCAD. The SCAD had occurred in the distal right coronary artery (RCA), the mid left anterior descending artery (LAD), and the distal LAD at the same time. His culprit lesion was in the distal RCA, but the SCAD had progressed more proximally within the RCA 12 days later with no clinical symptoms. We treated the mid LAD with implantation of a drug-eluting stent on admission and the SCAD had not progressed 12 days later. Moreover, the SCAD in the distal RCA and distal LAD healed spontaneously 12 days later. He had no recurrent attack, and all SCAD lesions of the RCA and LAD had completely healed 6 months later. Given that SCAD appears in various forms over the clinical course, a strategy of intervention needs careful consideration.
Highlights
Spontaneous coronary artery dissection (SCAD) is a rare condition that predominantly affects young healthy women
We report on a case of a middleaged male patient with an inferior non-ST segment elevation myocardial infarction (NSTEMI) caused by multivessel
We evaluated a male patient with NSTEMI caused by multivessel SCAD
Summary
Spontaneous coronary artery dissection (SCAD) is a rare condition that predominantly affects young healthy women. It can sometimes cause serious outcomes because of sudden death and acute coronary syndrome (ACS). The clinical features that give rise to suspicion of SCAD are (a) myocardial infarction (MI) in young women, especially those aged ≤50 years, (b) the absence of traditional cardiovascular risk factors, (c) little or no evidence of typical atherosclerotic lesions in the coronary arteries, (d) a peripartum condition, (e) a history of fibromuscular dysplasia (FMD), and (f) either emotional or physical (intensive exercise) precipitating stress events [1,2,3]. It has been reported that the frequency of ACS caused by multivessel SCAD was relatively high (observed in approximately 20% of cases), but the effects of interventional in-hospital treatment and long-term outcomes remain controversial [4,5,6]. The SCAD in the distal right coronary artery (RCA) progressed more proximally but healed naturally with conservative treatment
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