[Non-ST-Segment Elevation Myocardial Infarction Caused by Spontaneous Coronary Thrombosis by Intimal Rupture].

Medical history We report on a 51-year-old male patient with thoracic pain of acute onset with radiation in the left arm. His cardiovascular risk factors include obesity, smoking and arterial hypertension. Investigations ECG showed no signs of ischemia. The blood test revealed increasing troponin (37 pg/ml; Norm < 14 pg/ml). Therefore we performed cardiac catheterization. The RIVA demonstrated a medial filling defect. Use of OCT imaging showed intimal rupture associated with thrombus. Treatment and course The lesion was stented with a drug eluting stent. We initiated a medication with aspirin, ticagrelor, metoprolol and simvastatin. Conclusion Coronary thrombosis of our patient was caused by spontaneous coronary artery dissection (SCAD). SCAD is an important differential diagnosis in patients with ACS. Further prospective studies and guideline recommendations are needed in the future.