Spontaneous Coronary Artery Dissection: One Disease, Variable Presentations, and Different Management Approaches

Area of Science:

• Cardiology
• Vascular Medicine
• Emergency Medicine

Background:

• Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS).
• SCAD primarily affects younger females without traditional risk factors for atherosclerotic coronary artery disease.
• The condition presents with diverse clinical manifestations and carries a significant risk of mortality.

Purpose of the Study:

• To review different presentations and management strategies for SCAD.
• To highlight the importance of early diagnosis and appropriate treatment selection in SCAD patients.
• To evaluate the outcomes of various interventions in SCAD cases.

Main Methods:

• Case series of six patients with SCAD presenting with varying clinical scenarios (STEMI, NSTEMI, cardiac arrest).
• Treatment decisions based on patient presentation, clinical stability, and dissection extent.
• Diagnostic and procedural guidance utilizing intravascular ultrasound (IVUS) and optical coherence tomography (OCT).

Main Results:

• Four patients underwent emergent percutaneous coronary intervention (PCI).
• One patient initially treated medically underwent elective PCI due to persistent dissection.
• One patient with a small branch dissection and hemodynamic stability was managed medically; all patients achieved excellent outcomes.

Conclusions:

• A high index of suspicion is crucial for the timely diagnosis of SCAD.
• Emergent PCI offers excellent outcomes for patients with early presentation, limited disease, and ongoing symptoms.
• Medical management followed by elective PCI in select cases is a reasonable approach for stable patients.