A Case of Acute Myocardial Infarction Due to Primary Coronary Dissection

Abstract

A case of acute myocardial infarction associated with primary coronary dissection was followed up angiographically. A 46-year-old woman complained of chest oppression. Electrocardiogram on admission showed ST-segment elevation in V1-5. Urgent coronary angiography was performed under a diagnosis of acute anterior myocardial infarction, and showed a significant stenosis with multiple filling defects in segments 7-8 (99% with severe delay) in the left anterior descending artery. There was no organic lesion in the right coronary artery. Intracoronary thrombolytic therapy was unsuccessful, and thereafter she was treated with aspirin, warfarin and isosorbide dinitrate. Coronary angiography performed 1 month later revealed a long dissection with double lumens in segments 7-8. The septal branches emerged from the smaller lumen. Two months later, the 2 lumens were almost equal in size. These findings indicated that coronary dissection produced a false lumen with an entry in segment 7 and a reentry in segment 8, and that the false lumen was responsible for the greater flow. Four months later, the flow in the true lumen had improved remarkably while that in the false lumen had almost disappeared. She remained in stable condition during the follow-up period of 4 months.

Clinical perspectives of the primary spontaneous coronary artery dissection

“…Medical therapy with standard medications and careful follow-up has been used most often in stable patients [16,18,19,20]. In addition, coronary artery bypass, coronary catheter based interventions including stent placement, thrombolysis and glycoprotein IIB-IIIA inhibitor therapy have all been used successful, although in the acute phase, the thrombolytic therapy may be dangerous [3,14,17,[20][21][22].…”

“…In a report on 42 cases of spontaneous coronary artery dissection occurring in peripartum women, the short-term mortality was 49% and sudden cardiac death was the initial presentation in 28% of cases [4]. Conversely, there are reports where with conservative treatment spontaneous coronary artery dissection patients did well at 4 months and 10 years follow up [10,19]. In general, the long-term prognosis of the patients with spontaneous coronary artery dissection is considered favorable if they survive the acute phase [3,6,7,10,21].…”

A Spontaneous Coronary Artery Dissection Case Noticed during a Primary PCI

“…Conservative medical management may be an option [5, 6]. It is rational to give antiplatelet therapy because of the potential limitation of the flow caused by platelet rich thrombi [7].…”

Spontaneous Coronary Artery Dissection Causing Myocardial Infarction and Left Ventricular Aneurysm.

“…There have been case reports of conservative therapy from Japan; Osaki et al reported a case in which the dissection had not changed on follow-up CAG after 10 years 8 and Oka et al reported a case in which the false lumen of the dissection regressed after 4 months of conservative treatment. 9 This suggests that medical treatment with careful follow-up can be an acceptable treatment of choice, but on the other hand, DeMaio et al 3 reported that 80% of all patients of SCAD died directly from the dissection because of acute MI. In general, the prognosis of patients with SCAD is thought be favorable if they survive the acute phase.…”