scholarly journals Spontaneous coronary artery dissection as a cause of acute myocardial infarction with ST elevation

2021 ◽  
pp. 35-35
Author(s):  
Vladimir Ivanovic ◽  
Dragana Dabovic ◽  
Milovan Petrovic ◽  
Igor Ivanov ◽  
Marija Bjelobrk
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Intravascular Imaging ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Diagonal Branch ◽  
St Elevation

Introduction. Spontaneous coronary artery dissection (SCAD) is defined as a dissection that hasn?t occurred with atherosclerosis, trauma, or hasn?t developed iatrogenically. Case outline. A 53-year-old man admitted to the hospital due to chest pain and ischemic electrocardiographically changes (ECG). Coronarography was performed and 85% of the stenosis of the first diagonal branch (D1) was registered. During the percutaneous coronary intervention (PCI), one drug-eluting was directly implanted into the D1. About 3 hours after the intervention, the patient developed an acute myocardial infarction with ST elevation (STEMI) and recoronarography was performed. The previously implanted stent in D1 was patent without thrombi. The subocclusive stenosis of the LAD was registered and PCI was performed. After implantation of the stents into the LAD, propagation of dissection towards LCx was creating significant stenosis. Following the registration of the stenosis, PCI was performed on this branch. In order to determine the cause of acute STEMI, intravascular imaging was performed, seven days after last PCI. Optical coherence tomography showed an excellent stent apposition and expansion. In the area under the stents, in the proximal segment of LAD and LCX, showed duplication in the blood vessel wall. This duplication represents an unresorbed intramural hematoma as a consequence of SCAD. Conclusion. When performing coronarography on younger patients, women in the peripartum and patients with connective tissue disorders should think on SCAD. Usage of the intravascular imaging could reduce the number of unrecognized SCAD.

Abstract 13596: The Prognostic Impact of Spontaneous Coronary Artery Dissection in Younger Female Patients with Acute Myocardial Infarction; Report from Angina Pectoris-Myocardial Infarction Multicenter Investigations in Japan

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Takahiro Nakashima ◽  
Satoshi Yasuda ◽  
Teruo Noguchi ◽  
Seiichi Haruta ◽  
Yusuke Yamamoto ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Prognostic Impact ◽  
Coronary Risk Factors ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Clinical Prognosis

Introduction: Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial infarction (AMI). It is postulated that the patients with SCAD have good clinical prognosis because they have few coronary risk factors (CRF). However, a recent report studying the US patients with SCAD aged 18~78 years suggested that the rate of recurrence was higher than we expected. In the present study, we therefore have focused on prognostic impact of SCAD on younger female populations. Methods: A total of 16,233 AMI patients registered by 10 institutes from 1991 to 2012 were retrospectively studied. The definition of SCAD was based on the presence of medial dissection or intramural hematoma that was recognized by angiography before any catheter intervention. Results: There were 27 patients diagnosed as SCAD (male/female 1/26, age 45±9 [SD] years). The overall prevalence of SCAD was 0.17% of AMI patients. SCAD developed after physical or emotional stress in 11 patients (40.7%). The left anterior descending artery was involved in 17 patients (62.9%), among whom 4 patients had multi-vessel SCAD (14.8%). Recurrences of SCAD were shown in 9 patients (33.3%). In 4 of 9, recurrence was seen in previously unaffected coronary arteries. In young population of AMI patients (age <50), we compared clinical parameters of SCAD (n=21) with those of Non-SCAD groups (atherosclerotic, n=35). In SCAD group, the number of CRF was significantly lower than in Non-SCAD groups (SCAD, 1.0+/-0.8 vs Non-SCAD, 2.2+/-1.1, P<0.0001). In Kaplan-Meier analysis, younger female AMI patients with SCAD showed significantly higher rate of cardiac event (death, AMI and heart failure) in comparison with those without SCAD (SCAD, 11/21 vs Non-SCAD, 4/34; P=0.0002) during a median follow-up of 1557 (1-8172) days. Conclusions: The present multicenter study demonstrated that younger female AMI patients with SCAD, characterized as minimum accumulation of CRF, seem to be prone to cardiac events.

Recognition of acute myocardial infarction caused by spontaneous coronary artery dissection of first septal perforator

2021 ◽  
Author(s):  
Scott W Sharkey ◽  
Mesfer Alfadhel ◽  
Christina Thaler ◽  
David Lin ◽  
Meagan Nowariak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Acute Chest Pain ◽  
Vancouver General Hospital ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Septal Perforator

Abstract Aims  Spontaneous coronary artery dissection (SCAD) diagnosis is challenging as angiographic findings are often subtle and differ from coronary atherosclerosis. Herein, we describe characteristics of patients with acute myocardial infarction (MI) caused by first septal perforator (S1) SCAD. Methods and results  Patients were gathered from SCAD registries at Minneapolis Heart Institute and Vancouver General Hospital. First septal perforator SCAD prevalence was 11 of 1490 (0.7%). Among 11 patients, age range was 38–64 years, 9 (82%) were female. Each presented with acute chest pain, troponin elevation, and non-ST-elevation MI diagnosis. Initial electrocardiogram demonstrated ischaemia in 5 (45%); septal wall motion abnormality was present in 4 (36%). Angiographic type 2 SCAD was present in 7 (64%) patients with S1 TIMI 3 flow in 7 (64%) and TIMI 0 flow in 2 (18%). Initial angiographic interpretation failed to recognize S1-SCAD in 6 (55%) patients (no culprit, n = 5, septal embolism, n = 1). First septal perforator SCAD diagnosis was established by review of initial coronary angiogram consequent to cardiovascular magnetic resonance (CMR) demonstrating focal septal late gadolinium enhancement with corresponding oedema (n = 3), occurrence of subsequent SCAD event (n = 2), or second angiogram showing healed S1-SCAD (n = 1). Patients were treated conservatively, each with ejection fraction &gt;50%. Conclusion  First septal perforator SCAD events may be overlooked at initial angiography and mis-diagnosed as ‘no culprit’ MI. First septal perforator SCAD prevalence is likely greater than reported herein and dependent on local expertise and availability of CMR imaging. Spontaneous coronary artery dissection events may occur in intra-myocardial coronary arteries, approaching the resolution limits of invasive coronary angiography.

scholarly journals Spontaneous Coronary Artery Dissection – A Case Report

2018 ◽  
Vol 12 (2) ◽  
pp. 105-107
Author(s):  
Samsun Nahar ◽  
Fatema Begum ◽  
Momenuzzaman ◽  
KN Khan
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Chest Pain ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
St Elevation ◽  
The Right ◽  
Spontaneous Dissection

Spontaneous coronary artery dissection is a rather rare cause of myocardial infarction, chest pain, and sudden death.There are currently no known direct causes of this condition.Most of the reported dissections have occurred in the left anterior descending coronary artery.Herein, we report the case of a 58-year-old woman who presented at our institution with an acute ST-elevation myocardial infarction secondary to a spontaneous dissection of the right coronary artery. Primary PCIresolved the occlusion of the artery, and the patient was discharged from the hospital on medical therapy.University Heart Journal Vol. 12, No. 2, July 2016; 105-107

Spontaneous Coronary Artery Dissection in the Gulf: G-SCAD Registry

Angiology ◽  
2020 ◽  
Vol 72 (1) ◽  
pp. 32-43
Author(s):  
Amin Daoulah ◽  
Salem M. Al-Faifi ◽  
Sameer Alhamid ◽  
Ali A. Youssef ◽  
Mohammed Alshehri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Gulf Countries ◽  
Percutaneous Coronary ◽  
St Elevation

Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events ( P = .029).

scholarly journals Spontaneous Coronary Artery Dissection: A Rare Threat to Young Women

2012 ◽  
Vol 32 (4) ◽  
pp. e19-e26 ◽  
Author(s):  
Linda Griego Martinez
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Young Women ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Vigorous Exercise ◽  
Early Postpartum ◽  
St Elevation ◽  
Artery Disease

Spontaneous coronary artery dissection not associated with underlying coronary artery disease is rare. When the dissection does occur, it most often is manifested as an acute ST-elevation myocardial infarction in young women. Although the condition can occur in men, most often it involves women who are in their third trimester of pregnancy or the early postpartum period or are engaging in vigorous exercise. Because little is known about spontaneous coronary artery dissection in this population of women, recommendations for treatment are the same as for treatment of acute myocardial infarction associated with atherosclerotic coronary disease.

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