title: Spontaneous coronary artery dissection: Case series and review of literature.
abstract: OBJECTIVE
  Spontaneous coronary artery dissection (SCAD) is a less recognized cause of ST elevation myocardial infarction (STEMI) in clinical practice. The aim of this communication is to describe a case series in South Asian population and highlight on the long-term clinical outcomes on conservative management.
  
  
  METHODS
  A retrospective analysis of data of five patients (6 instances) of SCAD managed in a tertiary care center during January 1994 to June 2015 was done. Clinical, angiographic, therapeutic, and follow-up data till end of June 2015 are analyzed.
  
  
  RESULTS
  All patients were young (mean - 33 years) and predominantly male. Etiology of SCAD was diverse and included peripartum state, vigorous activity and atherosclerosis. Left anterior descending (LAD) coronary artery was predominantly involved and the majority had angiographic type 1 SCAD. Medical treatment provides excellent long-term benefits. Coronary stenting provided symptomatic benefit in a patient with favorable anatomy.
  
  
  CONCLUSIONS
  Clinical recognition of SCAD is difficult. It should be suspected in peripartum state, young females and in presence of other precipitating factors. Coronary angiography is essential for establishing the diagnosis. Medical treatment provides favorable long-term survival.
  The awareness of SCAD is important for all clinicians involved in STEMI care. A prompt suspicion can avoid administration of thrombolytic therapy. Early coronary angiography will provide an accurate diagnosis and help in deciding appropriate therapy. Percutaneous intervention can be challenging.
authors.affiliation: Professor and Head of Cardiology and Interventional Cardiologist, Department of Cardiology, Bombay Hospital and Bombay Hospital Institute of Medical Sciences, Mumbai, India.
authors.forename: Satyavan
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Senior Registrar, Department of Cardiology, Bombay Hospital and Bombay Hospital Institute of Medical Sciences, Mumbai, India. Electronic address: nikhs85@gmail.com.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Raut
authors.affiliation: Honorary Cardiologist, Department of Cardiology, Bombay Hospital and Bombay Hospital Institute of Medical Sciences, Mumbai, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Potdar
mesh_terms: D000293:Adolescent; D000328:Adult; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000175:diagnosis* / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D014652:Vascular Diseases / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery; D055815:Young Adult
keywords: Coronary artery dissection; ST elevation myocardial infarction; Spontaneous coronary artery dissection