Spontaneous coronary artery dissection causing acute coronary syndrome: an early diagnosis implies a good prognosis

• Published in: The American journal of emergency medicine Vol. 21; no. 7; pp. 549 - 551
• Main Authors: Roig, Sebastian, Gómez, José A, Fiol, Miguel, Guindo, Josep, Pérez, Jon, Carrillo, Andrés, Esplugas, Enrique, De Luna, Antonio Bayés
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-11-2003; Elsevier; Elsevier Limited
• Subjects: Acute coronary syndromes; Acute Disease; Adult; Aneurysm, Dissecting - complications; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - therapy; Angina pectoris; Angina, Unstable - diagnosis; Angina, Unstable - etiology; Angina, Unstable - therapy; Angioplasty; Angioplasty, Balloon, Coronary; Autopsies; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Connective tissue; Contraceptives; Coronary Aneurysm - complications; Coronary Aneurysm - diagnosis; Coronary Aneurysm - therapy; Coronary Angiography; Coronary Artery Bypass; Coronary artery dissection; Coronary heart disease; Coronary vessels; Dissection; Electrocardiography; Emergency medical care; Female; Females; Heart; Heart attacks; Heart surgery; Hematoma; Humans; Hypertension; Iatrogenesis; Ischemia; ischemic heart disease; Male; Medical imaging; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Myocardial Infarction - therapy; Patients; Postpartum period; Prognosis; Retrospective Studies; Stents; Syndrome; Womens health; ischemic heart disease; Coronary artery dissection; Human; Heart; Myocardial infarction; Prognosis; Radiodiagnosis; Angiography; Spontaneous; Coronary artery; Cardiovascular disease; Male; Instrumental dilatation; Coronary heart disease; Stent; Arterial disease; Vascular disease; Dissecting aneurysm; Case study; Bypass; Surgery; Adult; Complication; Female; Diagnosis
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2003.08.010

Spontaneous coronary artery dissection is an unusual cause of acute coronary syndrome. We describe a series of cases that with an early diagnosis and aggressive treatment, which includes percutaneous angioplasty with stent implantation and cardiac surgery, had a good outcome. The objective was to study the demographic characteristics, clinical settings, treatments, and inhospital course of patients with spontaneous coronary artery dissection. We studied a retrospective case series in 3 coronary care units in third-level university hospitals. The spontaneous coronary artery dissection diagnosis was made by coronary angiography. Seven cases of spontaneous coronary artery dissections were recorded. They were 5 women and 2 men. The age range was 28 to 64 years. Two of them took oral contraceptives and one case occurred in the postpartum period. An acute anterior wall myocardial infarction was the most frequent clinical presentation, occurring in 4 of the 7 cases. In fact, the left anterior descending artery was involved in 6 cases. An urgent coronary angiogram was performed in all cases. Definitive treatment included percutaneous angioplasty and stent implantation in 3 cases, coronary artery bypass surgery in 2 case, and cardiac transplantation in another case. One patient was treated medically. None of the patients died in the hospital. Spontaneous coronary artery dissection remains an unusual cause of acute coronary syndrome. It should be included in the differential diagnosis of acute myocardial infarction, especially when it affects young, healthy females. An early clinical suspicion and diagnosis with urgent coronary angiography and aggressive treatment that includes percutaneous angioplasty with stent implantation and cardiac surgery could improve the prognosis of these patients.