Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction

STEMI in young women: Don't miss spontaneous coronary artery dissection!

“…In the largest series of SCAD patients presenting with STEMI, the prevalence of SCAD in women less than 50 years old was 19%. 3 In this issue of Catherization and Cardiovascular Interventions, Vautrin et al 4 The most striking finding was that among these young patients presenting with STEMI, the prevalence of SCAD was significantly higher in women compared to men (22 vs. 3%) consistent with other studies. Among women the majority of SCAD cases were Type 2 SCAD and the left anterior descending artery was the most affected vessel consistent with prior studies.…”

“…Spontaneous coronary artery dissection (SCAD) should be suspected in a young woman without typical atherosclerotic risk factors presenting with acute myocardial infarction. In the largest series of SCAD patients presenting with STEMI, the prevalence of SCAD in women less than 50 years old was 19% 3 …”

“…5 Similarly, Lobo et al showed favorable in-hospital and three-year outcomes in STEMI patients with a 98% survival in SCAD compared to an 84% survival for age/sex matched patients with artherosclerosis. 3 This low mortality was striking in light of the high-risk features in the SCAD patients (19% cardiogenic shock, 13% left main and 16% out of hospital cardiac arrest). 3 In conclusion, this study highlights sex differences in STEMI in young patients under 45 years of age.…”

“…3 This low mortality was striking in light of the high-risk features in the SCAD patients (19% cardiogenic shock, 13% left main and 16% out of hospital cardiac arrest). 3 In conclusion, this study highlights sex differences in STEMI in young patients under 45 years of age. Among young women presenting with STEMI, 22% had SCAD.…”

Association of Pregnancy With Recurrence of Spontaneous Coronary Artery Dissection Among Women With Prior Coronary Artery Dissection

“…Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of acute coronary syndrome that occurs in women of childbearing age. 1 , 2 It is the cause of ST-elevation myocardial infarction (MI) in 1 of 5 women younger than age 50 years 3 and a foremost cause of heart attack among pregnant women. 1 , 4 , 5 Acute SCAD causes MI or sudden cardiac death due to obstruction by a coronary artery wall hematoma alone or a hematoma and an intimal-medial tear.…”