PMID- 25484560
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20141208
LR  - 20200930
IS  - 1061-1711 (Print)
IS  - 1615-5939 (Electronic)
IS  - 1061-1711 (Linking)
VI  - 23
IP  - 4
DP  - 2014 Dec
TI  - Spontaneous Coronary Artery Dissection and Hemodynamic Instability: Can Emergent 
      PCI Be Life Saving? Report of Two Cases and Literature Review.
PG  - 275-80
LID - 10.1055/s-0033-1349163 [doi]
AB  - Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary 
      syndrome. It occurs predominantly among younger females and typically in the 
      absence of atherosclerotic coronary artery disease. It is associated with 
      peripartum period, connective tissue disorders, vasculitides, and extreme 
      exertion. Presentations vary greatly, and this condition can be fatal. Given its 
      rarity, there are no guidelines for management of SCAD. We present the cases of 
      two female patients, with no coronary artery disease risk factors or recent 
      pregnancy, who were presented with non-ST elevation myocardial infarction 
      (NSTEMI) and ST elevation myocardial infarction (STEMI), respectively, secondary 
      to SCAD. Both had excellent outcome after emergent percutaneous intervention. Our 
      first patient was presented with NSTEMI with ongoing chest pain and dynamic 
      electrocardiogram (ECG). Emergent left heart catheterization was significant for 
      first obtuse marginal (OM1) dissection, confirmed by optical coherence 
      tomography. Percutaneous coronary intervention (PCI) with two bare metal stents 
      was performed with resolution of symptoms and ECG changes. The second patient is 
      known to have syndrome, presented with STEMI and emergent coronary angiography 
      showed left anterior descending dissection with intramural hematoma confirmed by 
      intravascular ultrasound and treated with a drug-eluting stent with resolution of 
      symptoms and ST changes. Her hospital course was complicated by post-myocardial 
      infarction pericarditis that was improved with colchicine. Both the patients were 
      observed in the coronary care unit for 24 hours. Both remained asymptomatic at 
      6-month follow-up. SCAD is a rare cause of acute coronary syndrome. In patients 
      with early presentation, limited disease, and ongoing symptoms, emergent cardiac 
      catheterization with percutaneous intervention has excellent outcome. More 
      studies are needed to establish evidence-based management guidelines.
FAU - Al Emam, Abdel Rahman A
AU  - Al Emam AR
AD  - Department of Internal Medicine, University Of Texas Medical Branch, Galveston, 
      Texas.
FAU - Almomani, Ahmed
AU  - Almomani A
AD  - Department of Internal Medicine, University Of Texas Medical Branch, Galveston, 
      Texas.
FAU - Gilani, Syed A
AU  - Gilani SA
AD  - Division of Cardiology, University Of Texas Medical Branch, Galveston, Texas.
LA  - eng
PT  - Case Reports
PL  - United States
TA  - Int J Angiol
JT  - The International journal of angiology : official publication of the 
      International College of Angiology, Inc
JID - 9504821
PMC - PMC4244243
OTO - NOTNLM
OT  - PCI
OT  - acute coronary syndrome
OT  - dissection
OT  - myocardial infarction
EDAT- 2014/12/09 06:00
MHDA- 2014/12/09 06:01
PMCR- 2015/12/01
CRDT- 2014/12/09 06:00
PHST- 2014/12/09 06:00 [entrez]
PHST- 2014/12/09 06:00 [pubmed]
PHST- 2014/12/09 06:01 [medline]
PHST- 2015/12/01 00:00 [pmc-release]
AID - 130032 [pii]
AID - 10.1055/s-0033-1349163 [doi]
PST - ppublish
SO  - Int J Angiol. 2014 Dec;23(4):275-80. doi: 10.1055/s-0033-1349163.