title: Emergency Department Presentation of Patients with Spontaneous Coronary Artery Dissection.
abstract: BACKGROUND
  Spontaneous coronary artery dissection (SCAD) is an infrequently recognized but potentially fatal cause of acute coronary syndrome (ACS) that disproportionately affects women. Little is currently known about how patients with SCAD initially present.
  
  
  OBJECTIVE
  We sought to describe patients who presented to the emergency department (ED) with symptoms of SCAD to improve providers' awareness and recognition of this condition.
  
  
  METHODS
  We performed a retrospective medical record review of all patients who presented to the ED of a single academic medical center from January 1, 2002 through October 31, 2015 and were subsequently diagnosed with SCAD by angiography. These patients were identified by International Classification of Diseases, Ninth Revision codes and a Boolean search of the diagnosis field of the medical record. Data regarding patients' presentations and course were abstracted by two independent reviewers.
  
  
  RESULTS
  We identified 20 episodes of SCAD involving 19 patients, all of whom were female. The majority of patients had 0-1 conventional cardiovascular disease risk factors. Most patients had chest pain (85%), initial electrocardiograms without evidence of ischemia (85%), and elevated initial troponin (72%). The most common diagnosis in providers' differential was acute coronary syndrome (ACS).
  
  
  CONCLUSIONS
  Patients with SCAD present with similar symptoms compared to patients with ACS caused by atherosclerotic disease, but have different risk profiles. Providers should consider SCAD in patients presenting with symptoms concerning for ACS, especially in younger female patients without traditional cardiovascular disease risk factors, as their risk may be significantly underestimated with commonly used ACS risk-stratifiers.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Lindor
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Marysia S
authors.initials: MS
authors.lastname: Tweet
authors.affiliation: Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Kiran A
authors.initials: KA
authors.lastname: Goyal
authors.affiliation: Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gulati
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Sharonne N
authors.initials: SN
authors.lastname: Hayes
authors.affiliation: Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Annie T
authors.initials: AT
authors.lastname: Sadosty
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000150:complications; D002637:Chest Pain / Q000209:etiology; D003330:Coronary Vessel Anomalies / Q000175:diagnosis* / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014652:Vascular Diseases / Q000151:congenital* / Q000175:diagnosis / Q000503:physiopathology
keywords: acute coronary syndrome; spontaneous coronary artery dissection