Multivessel Spontaneous Coronary Artery Dissection in Non-ST-Segment Elevation Myocardial Infarction: Compassion Instead of Stenting.

BACKGROUND

Spontaneous coronary artery dissection is an important nonatherosclerotic cause of acute coronary syndrome, particularly in women with few conventional cardiovascular risk factors.

CASE SUMMARY: A 62-year-old woman without traditional risk factors presented with non-ST-segment elevation myocardial infarction. Coronary angiography showed severe, smooth diffuse narrowing of the left anterior descending artery and a large diagonal branch. Detailed history taking identified intense grief over her son's approaching birthday after his COVID-19-related death the previous year. Intravascular ultrasound confirmed extensive coronary artery dissection with intramural hematoma. Conservative management with supportive psychotherapy, anti-ischemic medications, and cardiac rehabilitation was implemented. Six-month follow-up angiography showed complete healing.

DISCUSSION: Complex stenting across the distal left main-left anterior descending artery and left anterior descending artery-diagonal bifurcations would have carried substantial procedural and long-term risks.

TAKE-HOME MESSAGE: Because spontaneous healing is common in spontaneous coronary artery dissection, careful history taking, meticulous angiographic review, and adjunctive intravascular imaging are crucial for accurate diagnosis.