From Subtle to severe: The SCAD Spectrum in Action: A Case series of 5 Patients with Literature Review

Abstract

Spontaneous coronary artery dissection is an under-recognized cause of acute coronary syndrome, especially in middle-aged women without conventional atherosclerotic risk factors. We present a series of five patients (three women, two men; mean ages 60 and 51 years, respectively) who presented with acute chest pain or progressive angina. Electrocardiographic findings ranged from ST-segment elevation to non-ST-elevation patterns. Coronary angiography demonstrated type I, type IIB or type III spontaneous coronary artery dissection according to the Saw classification, predominantly involving the mid-to-distal left anterior descending artery; one patient had concomitant mid-right coronary artery occlusion. Four patients were managed conservatively with single antiplatelet therapy, beta-blockers and blood-pressure control; one required stenting of an occluded right coronary artery. All recovered without recurrence during short-term follow-up. The series underscores the need for a high index of suspicion, careful angiographic interpretation and individualized decisions between conservative therapy and revascularization.