Spontaneous Coronary Artery Dissection: Case Series and Review of Associated Cardiovascular Risks

Area of Science:

• Cardiology
• Vascular Biology

Background:

• Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome (ACS), particularly in young women.
• Historically, SCAD was considered rare and primarily associated with fibromuscular dysplasia or connective tissue disorders.
• Emerging evidence suggests SCAD may be linked to traditional cardiovascular risk factors.

Purpose of the Study:

• To investigate the prevalence of cardiovascular risk factors in patients diagnosed with SCAD.
• To identify potential contributing factors and disease mechanisms in SCAD.
• To evaluate management strategies and outcomes for SCAD patients.

Main Methods:

• Retrospective analysis of 13 consecutive SCAD patients across three institutions over five years.
• Review of patient demographics, cardiovascular risk factors, and diagnostic findings.
• Assessment of treatment approaches and clinical outcomes.

Main Results:

• SCAD represented 0.5% of cardiac catheterizations for chest pain.
• The average patient age was 49.3 years, with 84% being women.
• Associated risk factors included hyperlipidemia (61%), hypertension (46%), and prediabetes (8%).
• Elevated D-dimer levels were observed in 38% of patients; inflammatory markers were infrequent.
• No cases of fibromuscular dysplasia or connective tissue disorders were identified.
• Most patients were managed conservatively with dual antiplatelet therapy, achieving excellent outcomes.

Conclusions:

• SCAD in this cohort frequently correlated with traditional cardiovascular risk factors, suggesting a role for endothelial vulnerability.
• Elevated D-dimer may indicate disease activity in SCAD.
• Conservative management with dual antiplatelet therapy is effective for most SCAD patients.
• Increased clinical awareness is crucial for timely SCAD diagnosis and management.