Britel Driss, Nikièma Soumaila, Massimbo Désiré, Graham Emmanuel, Benyass Aatif, Lakhal Zouhair
Department of Cardiology, Mohammed V Military Instruction Hospital, Morocco, Rabat.
Ann Med Surg (Lond). 2023 Jan 18;85(1):32-36. doi: 10.1097/MS9.0000000000000095. eCollection 2023 Jan.
Spontaneous coronary artery dissection (SCAD) is often revealed by an acute coronary syndrome classified then as a MINOCA. The typical patient is a female patient with no or few cardiovascular risk factor. Our work aims to illustrate the effectiveness of medical treatment in patients with SCAD.
We report a case of a 56-year-old female patient who was admitted after 3 days of infarct-like thoracic pain related to an anterior extended ST-elevation myocardial infarction. The coronarography showed a SCAD of the left anterior descending coronary artery. The patient was discharged under medical treatment. Six weeks later, coronarography showed a perfused coronary artery.
Most cases of SCAD present as acute coronary syndrome. Coronary angiography remains the 'first-line' examination. The use of endocoronary imaging such as IVUS and optical coherence tomography is necessary in case of diagnostic doubt (especially in SCAD type 2 and 3). The optimal management of SCAD remains unclear. A conservative approach should be the preferred strategy.
SCAD should be considered in any young woman presenting with suspicious chest pain with positive troponin. The diagnosis is initially angiographic and may require endocoronary imaging for greater accuracy. Conservative treatment remains the best option.
自发性冠状动脉夹层（SCAD）常表现为急性冠状动脉综合征，随后被归类为心肌梗死伴非阻塞性冠状动脉病变（MINOCA）。典型患者为无或仅有少数心血管危险因素的女性患者。我们的工作旨在阐明药物治疗对SCAD患者的有效性。
我们报告一例56岁女性患者，因类似梗死的胸痛持续3天后入院，诊断为前壁广泛ST段抬高型心肌梗死。冠状动脉造影显示左前降支冠状动脉发生SCAD。该患者经药物治疗后出院。六周后，冠状动脉造影显示冠状动脉血运灌注良好。
大多数SCAD病例表现为急性冠状动脉综合征。冠状动脉造影仍是“一线”检查方法。在诊断存疑时（尤其是2型和3型SCAD），使用血管内超声（IVUS）和光学相干断层扫描等冠状动脉内成像检查是必要的。SCAD的最佳治疗方案仍不明确。保守治疗应是首选策略。
对于任何出现可疑胸痛且肌钙蛋白阳性的年轻女性，均应考虑SCAD。最初的诊断依靠血管造影，可能需要冠状动脉内成像以提高诊断准确性。保守治疗仍是最佳选择。
