Spontaneous Coronary Artery Dissection: A Case Series of 8 Patients with Literature Review

Abstract

Introduction: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes, affecting a mainly female population with few cardiovascular risk factors, with an incidence of 0.07–0.2% of all angiograms and 2–4% of angiograms performed for acute coronary syndrome (ACS) .It is defined by a spontaneous, non-traumatic and non-iatrogenic separation of the coronary wall, in the absence of an associated atheromatous lesion. The pathophysiology is heterogeneous, including hormonal influences, arteriopathies, and precipitating intense physical or emotional stressors. Methods and results: Between 2018 and 2020, 8 cases of SCAD were collected from a database our cardiology unit. The mean age was 46 years with a female exclusive and 47% of patients were under 50 years old. Three patients (37.5%) had no cardiovascular risk factor (CVRF). One patient had SCAD in a peripartum setting with a personal and a family history of fibromuscular dysplasia. All our patients were admitted for ACS, the half of them presented a ST-segment elevation myocardial infarction (STEMI), and the other half presented non-STEMI. In all de cases the diagnosis was confirmed by angiography alone. All patients were managed with conservative approach in the early and late phases. The anterior interventricular artery (AIV) was most frequently involved in 62.5% of cases. No endocoronary imaging was required; 37.5% were classified as Type 1, 37.5% as Type 2 and 50% as type 4. No lesions were classified as Type 3. The cardiac computed tomography angiography (CCTA) control was performed in 62.5% between 1 and 6 months. The extracoronary workup was performed in 37.5% of the cases and revealed lesions in 66% of the cases. Conclusion: The data from this study are consistent with the literature, and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of SCAD for prompt diagnosis and management......