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

Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome, myocardial infarction, and sudden cardiac death, particularly in young women with few established risk factors. We performed a retrospective analysis of 13 consecutive patients diagnosed with SCAD across 3 institutions over 5 years to identify associated cardiovascular risk factors. SCAD accounted for 0.5% of all cardiac catheterizations for chest pain. The average age was 49.3 years, and 84% of them were women. Of those with hyperlipidemia, 61% had it, 46% had hypertension, and 8% had prediabetes. There were no indications of fibromuscular dysplasia or connective tissue disorders in any patients. A mean D-dimer level of 1,578 ng/dL was observed in 38% of individuals, while elevated inflammatory markers were infrequently present. Only 1 patient required percutaneous coronary intervention; the remaining patients were managed conservatively with dual antiplatelet therapy, yielding excellent outcomes. Although historically considered nonatherosclerotic, SCAD in our sample frequently correlated with traditional cardiovascular risk factors, suggesting that endothelial vulnerability associated with these conditions may play a contributory role. Elevated levels of D-dimer may be a sign of disease activity. Most patients respond favorably to conservative treatment; enhanced clinical awareness is essential for prompt diagnosis and management.