Spontaneous coronary artery dissection: Case series with extended follow up

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.