Three-vessel spontaneous coronary artery dissection in a patient with hyperhomocysteinemia

Area of Science:

• Cardiology
• Genetics
• Vascular Biology

Background:

• Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, particularly in younger individuals.
• Long-term follow-up data for SCAD patients are scarce, limiting understanding of its natural history.
• Elevated homocysteine levels are implicated in arterial dissections, including coronary and cervical arteries.

Observation:

• A young male presented with a rare case of three-vessel SCAD, characterized by dissections in all three major coronary arteries.
• The patient exhibited hyperhomocysteinemia and a methylenetetrahydrofolate reductase (MTHFR) prothrombotic mutation.
• Despite extensive multi-vessel SCAD, the patient demonstrated long-term clinical stability of coronary artery disease.

Findings:

• Multi-vessel SCAD, though rare, can be associated with specific genetic predispositions like MTHFR mutations.
• Hyperhomocysteinemia may be a significant contributing factor in the pathogenesis of SCAD.
• Angiographic evidence of SCAD does not always correlate with immediate clinical deterioration.

Implications:

• Familiarity with the angiographic appearance of multi-vessel SCAD is crucial for accurate diagnosis.
• Identifying genetic factors like MTHFR mutations and metabolic conditions like hyperhomocysteinemia can aid in risk stratification for SCAD.
• The potential for long-term clinical stability in some SCAD patients warrants further investigation into prognostic factors and management strategies.