Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome.
It occurs predominantly among younger females and typically in the absence of atherosclerotic
coronary artery disease. It is associated with peripartum period, connective tissue
disorders, vasculitides, and extreme exertion. Presentations vary greatly, and this
condition can be fatal. Given its rarity, there are no guidelines for management of
SCAD. We present the cases of two female patients, with no coronary artery disease
risk factors or recent pregnancy, who were presented with non-ST elevation myocardial
infarction (NSTEMI) and ST elevation myocardial infarction (STEMI), respectively,
secondary to SCAD. Both had excellent outcome after emergent percutaneous intervention.
Our first patient was presented with NSTEMI with ongoing chest pain and dynamic electrocardiogram
(ECG). Emergent left heart catheterization was significant for first obtuse marginal
(OM1) dissection, confirmed by optical coherence tomography. Percutaneous coronary
intervention (PCI) with two bare metal stents was performed with resolution of symptoms
and ECG changes. The second patient is known to have syndrome, presented with STEMI
and emergent coronary angiography showed left anterior descending dissection with
intramural hematoma confirmed by intravascular ultrasound and treated with a drug-eluting
stent with resolution of symptoms and ST changes. Her hospital course was complicated
by post–myocardial infarction pericarditis that was improved with colchicine. Both
the patients were observed in the coronary care unit for 24 hours. Both remained asymptomatic
at 6-month follow-up. SCAD is a rare cause of acute coronary syndrome. In patients
with early presentation, limited disease, and ongoing symptoms, emergent cardiac catheterization
with percutaneous intervention has excellent outcome. More studies are needed to establish
evidence-based management guidelines.
Keywords
dissection - PCI - myocardial infarction - acute coronary syndrome
