title: Spontaneous coronary artery dissection: case series with extended follow up.
abstract: Spontaneous coronary artery dissection (SCAD) is atherosclerotic or non-atherosclerotic in origin. Eosinophilic infiltrate is identified in coronary artery adventitia in non-atherosclerotic SCAD. We postulate that a systemic inflammatory state causes SCAD in younger women who do not have significant coronary artery disease risk factors. We report a case series of 13 patients presenting with SCAD from ages 26-48 with follow up from 1 month to 13 years. Most patients did not have conventional risk factors for coronary artery disease (CAD). Approximately 50% of the patients developed recurrent dissection within the first 2 weeks of an index event, but < 25% were symptomatic during follow up. All patients were alive at follow up. Systemic inflammatory state was observed in 80% of patients who developed early recurrent dissection. SCAD should be strongly suspected in younger women presenting with acute coronary syndrome without CAD risk factors. Coronary dissection may recur within first 2 weeks, but patients have good long-term survival without new episodes of dissection. Broad rheumatologic and connective tissue disease work-up should be considered in young females presenting with SCAD.
authors.affiliation: Department of Internal Medicine, The State University of New York at Buffalo, Buffalo, NY 14221, USA. pkansara@buffalo.edu
authors.forename: Pranav
authors.initials: P
authors.lastname: Kansara
authors.forename: Susan
authors.initials: S
authors.lastname: Graham
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D003240:Connective Tissue Diseases / Q000150:complications; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015607:Stents; D016896:Treatment Outcome