Spontaneous coronary artery dissection: Case series and review of literature
Satyavan Sharma1, Nikhil Raut2, Anil Potdar3
1Professor and Head of Cardiology and Interventional Cardiologist, Department of Cardiology, Bombay Hospital and Bombay Hospital Institute of Medical Sciences, Mumbai, India.
Insights
Spontaneous coronary artery dissection (SCAD) is an underrecognized cause of heart attacks, particularly in young South Asians. Conservative management shows excellent long-term outcomes, emphasizing the need for clinical awareness and prompt diagnosis.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) is an infrequent yet significant cause of ST-elevation myocardial infarction (STEMI).
- This condition is often overlooked in clinical practice, especially within specific demographic groups.
Observation:
- A case series of five South Asian patients (six instances) with SCAD managed between 1994 and 2015 was analyzed.
- Patients were notably young (mean age 33 years) and predominantly male.
- Diverse etiologies including peripartum state, vigorous physical activity, and atherosclerosis were identified.
Findings:
- The Left Anterior Descending (LAD) artery was most frequently involved, with most cases exhibiting Type 1 SCAD angiographically.
- Conservative medical management demonstrated excellent long-term clinical benefits.
- Percutaneous coronary intervention (PCI) with stenting offered symptomatic improvement in a select patient with suitable anatomy.
Implications:
- Increased clinical suspicion for SCAD is crucial in patients presenting with STEMI, particularly young females, those in the peripartum state, or with other precipitating factors.
- Coronary angiography is essential for accurate diagnosis and guiding therapeutic decisions.
- While medical management is effective for long-term survival, percutaneous intervention can be technically challenging in SCAD cases.
Aim:
Spontaneous coronary artery dissection (SCAD) is a less recognized cause of ST elevation myocardial infarction (STEMI) in clinical practice. The aim of this communication is to describe a case series in South Asian population and highlight on the long-term clinical outcomes on conservative management.
Methods:
A retrospective analysis of data of five patients (6 instances) of SCAD managed in a tertiary care center during January 1994 to June 2015 was done. Clinical, angiographic, therapeutic, and follow-up data till end of June 2015 are analyzed.
Results:
All patients were young (mean - 33 years) and predominantly male. Etiology of SCAD was diverse and included peripartum state, vigorous activity and atherosclerosis. Left anterior descending (LAD) coronary artery was predominantly involved and the majority had angiographic type 1 SCAD. Medical treatment provides excellent long-term benefits. Coronary stenting provided symptomatic benefit in a patient with favorable anatomy.
Conclusions:
Clinical recognition of SCAD is difficult. It should be suspected in peripartum state, young females and in presence of other precipitating factors. Coronary angiography is essential for establishing the diagnosis. Medical treatment provides favorable long-term survival.
Implications And Practice:
The awareness of SCAD is important for all clinicians involved in STEMI care. A prompt suspicion can avoid administration of thrombolytic therapy. Early coronary angiography will provide an accurate diagnosis and help in deciding appropriate therapy. Percutaneous intervention can be challenging.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:30Acute Coronary Syndrome I: Introduction
01:30Coronary Artery Disease III: Clinical Manifestations