Poster No. 103 Spontaneous coronary artery dissection: when pain and ST-segment elevation persist

• Published in: Cardiovascular research Vol. 118; no. Supplement_2
• Main Authors: Lopes, Rafaela G, Cruz, Isabel, Oliveira, Inês Pereira, Bragança, Bruno, Campos, Inês G, Monteiro, Joel Ponte, Almeida, Carla, Castro, Alexandra, Andrade, Aurora
• Format: Journal Article
• Language: English
• Published: 21.10.2022
• ISSN: 0008-6363; 1755-3245
• DOI: 10.1093/cvr/cvac157.083

Abstract A 44-year-old female with nonrelevant medical history was admitted due to chest pain. She was hemodynamically stable. Normal physical examination. ECG with ST-segment depression in the inferior leads. Echocardiogram had no contractility abnormalities. High-sensitivity troponin I (hsTnI) of 164.4 pg/mL. Non-ST-segment elevation myocardial infarction (NSTEMI) diagnosis was made. 12 hours later she developed refractory chest pain. Emergent coronariography depicted independent ostia for the anterior descending and circumflex arteries and type 1 spontaneous coronary artery dissection (SCAD) of the circumflex artery. During angiography, pain subsided and a conservative approach was adopted. An hour later, she had recurrent pain refractory to medical treatment and new onset of persistent ST-segment elevation in leads V4-V6. It was decided to perform percutaneous coronary intervention and a drug eluting stent was placed in the proximal circumflex artery. There was distal propagation of the parietal hematoma, but TIMI 3 flow was restored. She was discharged on day 6. 5 days later she was readmitted due to NSTEMI. She had recurrent episodes of chest pain followed by reelevation of hsTnI. Coronary computer tomography depicted distal progression of the dissection with involvement of a first obtuse marginal and distal circumflex. After uptitration of anti-ischemic medication she was discharged. The case underlines the challenging and non-linear approach of SCAD in the setting persistent chest pain. Besides the technical difficulties of angioplasty, with higher risk of restenosis and stent failure, most recommendations support a conservative approach. However, persistent chest pain imply further action, as exemplified in this case report.