Multivessel Spontaneous Coronary Artery Dissection Linked to Antiphospholipid Syndrome.

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-01 DOI:10.1016/j.jaccas.2025.105532

Brittni McClellan, Dhruva Govil, Keyur Patel, Nick Serafimovski, Ali Huda, Marcel Zughaib

{"title":"Multivessel Spontaneous Coronary Artery Dissection Linked to Antiphospholipid Syndrome.","authors":"Brittni McClellan, Dhruva Govil, Keyur Patel, Nick Serafimovski, Ali Huda, Marcel Zughaib","doi":"10.1016/j.jaccas.2025.105532","DOIUrl":null,"url":null,"abstract":"Background: Spontaneous coronary artery dissection (SCAD) is a rare nonatherosclerotic cause of acute coronary syndrome, usually affecting young women without traditional risk factors. Currently, there is no definitive link between SCAD and autoimmune diseases such as antiphospholipid syndrome (APS).Case summary: A 51-year-old woman presented with anterior ST-segment elevation myocardial infarction due to multivessel SCAD of the mid left anterior descending artery and an intramural hematoma in a large obtuse marginal branch. Despite conservative management and Impella support, she developed an early extension of the obtuse marginal intramural hematoma 4 days later, complicated by a left ventricular thrombus. Subsequent evaluation confirmed APS.Discussion: This case illustrates multivessel SCAD with early extension in the setting of APS, highlighting critical challenges in the use of anticoagulation. Prolonged monitoring and autoimmune screening are crucial in atypical SCAD presentations. Mechanical circulatory support may assist in hemodynamic stability.Take-home message: APS should be considered for atypical SCAD presentations, with individualized multidisciplinary management to provide optimal outcomes.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"105532"},"PeriodicalIF":0.0000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Case reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.jaccas.2025.105532","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is a rare nonatherosclerotic cause of acute coronary syndrome, usually affecting young women without traditional risk factors. Currently, there is no definitive link between SCAD and autoimmune diseases such as antiphospholipid syndrome (APS).

Case summary: A 51-year-old woman presented with anterior ST-segment elevation myocardial infarction due to multivessel SCAD of the mid left anterior descending artery and an intramural hematoma in a large obtuse marginal branch. Despite conservative management and Impella support, she developed an early extension of the obtuse marginal intramural hematoma 4 days later, complicated by a left ventricular thrombus. Subsequent evaluation confirmed APS.

Discussion: This case illustrates multivessel SCAD with early extension in the setting of APS, highlighting critical challenges in the use of anticoagulation. Prolonged monitoring and autoimmune screening are crucial in atypical SCAD presentations. Mechanical circulatory support may assist in hemodynamic stability.

Take-home message: APS should be considered for atypical SCAD presentations, with individualized multidisciplinary management to provide optimal outcomes.

查看原文本刊更多论文

多支自发性冠状动脉夹层与抗磷脂综合征相关。

背景：自发性冠状动脉夹层（SCAD）是一种罕见的急性冠状动脉综合征的非动脉粥样硬化性原因，通常影响无传统危险因素的年轻女性。目前，SCAD与自身免疫性疾病如抗磷脂综合征（APS）之间没有明确的联系。病例总结：一名51岁女性，因左前降支多血管SCAD和大钝缘支壁内血肿而出现st段前抬高型心肌梗死。尽管保守治疗和Impella支持，4天后，她出现了钝性边缘壁内血肿的早期延伸，并伴有左室血栓。随后的评估证实APS。讨论：该病例说明了APS设置下早期扩展的多血管SCAD，突出了抗凝使用中的关键挑战。在非典型SCAD表现中，长期监测和自身免疫筛查至关重要。机械循环支持可能有助于血液动力学稳定性。关键信息：对于非典型SCAD表现，应考虑APS，并进行个性化的多学科管理，以提供最佳结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊