Emergency Department Presentation of Patients with Spontaneous Coronary Artery Dissection

Background

Spontaneous coronary artery dissection (SCAD) is an infrequently recognized but potentially fatal cause of acute coronary syndrome (ACS) that disproportionately affects women. Little is currently known about how patients with SCAD initially present.

Objectives

We sought to describe patients who presented to the emergency department (ED) with symptoms of SCAD to improve providers’ awareness and recognition of this condition.

Patients and Methods

We performed a retrospective medical record review of all patients who presented to the ED of a single academic medical center from January 1, 2002 through October 31, 2015 and were subsequently diagnosed with SCAD by angiography. These patients were identified by International Classification of Diseases, Ninth Revision codes and a Boolean search of the diagnosis field of the medical record. Data regarding patients’ presentations and course were abstracted by two independent reviewers.

Results

We identified 20 episodes of SCAD involving 19 patients, all of whom were female. The majority of patients had 0–1 conventional cardiovascular disease risk factors. Most patients had chest pain (85%), initial electrocardiograms without evidence of ischemia (85%), and elevated initial troponin (72%). The most common diagnosis in providers’ differential was acute coronary syndrome (ACS).

Conclusion

Patients with SCAD present with similar symptoms compared to patients with ACS caused by atherosclerotic disease, but have different risk profiles. Providers should consider SCAD in patients presenting with symptoms concerning for ACS, especially in younger female patients without traditional cardiovascular disease risk factors, as their risk may be significantly underestimated with commonly used ACS risk-stratifiers.