Recurrent STEMI caused by multivessel spontaneous coronary dissection

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction, particularly in younger women.
• Diagnosis often requires advanced imaging like optical coherence tomography (OCT).

Observation:

• A 52-year-old female presented with syncope, diagnosed with SCAD in the posterior descending artery.
• During hospitalization, she developed chest pain and ST elevation, revealing left anterior descending artery occlusion due to SCAD.
• Increased coronary adventitial vasa vasorum volume, a potential SCAD biomarker, was noted.

Findings:

• Initial conservative management for SCAD was followed by revascularization with stenting due to disease progression and hemodynamic compromise.
• OCT confirmed dissection in both instances, highlighting its utility in SCAD diagnosis and management.
• The case supports the hypothesis of increased vasa vasorum in SCAD patients.

Implications:

• This case underscores the importance of considering SCAD in patients with acute coronary syndromes.
• It illustrates the shift from conservative management to revascularization based on clinical presentation and disease severity.
• Further research into the role of vasa vasorum in SCAD pathogenesis and risk stratification is warranted.