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Primary coronary artery dissection: its incidence, mode of the onset and prognostic evaluation
H Nishikawa1, S Nakanishi, S Nishiyama
1Division of Cardiology, Toranomon Hospital, Tokyo.
Insights
Primary coronary artery dissection, though rare, occurs in myocardial infarction patients. This study found it in 0.28% of cases, with varied prognoses, suggesting a link to coronary vasospasm.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Primary coronary artery dissection (PCAD) is a rare cause of myocardial infarction (MI).
- Understanding its incidence, presentation, and outcomes is crucial for patient management.
- Coronary angiography is the gold standard for diagnosing coronary artery abnormalities.
Observation:
- This study investigated 1,445 patients with MI undergoing coronary angiography.
- PCAD was identified in 4 patients (0.28% incidence).
- Cases involved different coronary arteries and patient demographics, with varied clinical presentations.
Findings:
- Two patients experienced inferior MI linked to right coronary artery dissection, with good long-term recovery (NYHA class I).
- One patient with inferior MI and right coronary artery dissection recovered well.
- One patient with anterior MI due to left anterior descending artery dissection had a fatal outcome.
Implications:
- PCAD is not extremely rare and warrants consideration in MI cases.
- Coronary vasospasm may be associated with PCAD in some instances.
- Prognosis of PCAD varies, highlighting the need for individualized patient care and further research.
Abstract:
The incidence, mode of the onset and prognosis of primary coronary artery dissection in 1,445 consecutive patients with myocardial infarction undergoing coronary angiography were elucidated in the present study. Primary coronary artery dissection was observed in four patients (0.28%). The first case was a 28-year-old man, who developed angina at rest, followed by inferior myocardial infarction. His coronary angiogram showed dual lumina in the proximal to distal segments of the right coronary artery, which were separated by a flap. A left ventriculogram showed severe impairment of contraction (akinesis) in its inferior segment. Six years later, he was classified as New York Heart Association (NYHA) functional class I. The second case, a 54-year-old man, developed vasospastic angina followed by inferior myocardial infarction. His coronary angiogram showed a similar dissection from the proximal to distal segments of the right coronary artery. A left ventriculogram showed akinesis of the inferior segment and a coronary angiogram five years later showed marked resolution of the dissection. Twelve years after the infarction, he was classified as NYHA functional class I. The third case, a 46-year-old woman, experienced sudden onset of inferior myocardial infarction. Her coronary angiogram showed dissection from the middle to distal segments, and the posterior descending branch of the right coronary artery. A left ventriculogram showed akinesis of the inferior segment, and three years later, she was asymptomatic. The fourth case, a 28-year-old woman, developed anterior myocardial infarction following delivery. Her coronary angiogram revealed dissection from the proximal to middle segments of the left anterior descending artery. A left ventriculogram showed akinesis in the anteroseptal segment and dyskinesis in the apical segment. She died suddenly four years after her myocardial infarction. Thus, primary coronary artery dissection is not extremely rare and it may have been associated with coronary vasospasm in at least two of these four cases.