Critical Care Transport of Patients With Spontaneous Coronary Artery Dissection: A Case Series

Objective

Spontaneous coronary artery dissection (SCAD) refers to a naturally occurring tear or separation within the layers of the coronary artery walls. As a result, a blood-filled cavity forms within the coronary artery, obstructing blood flow to the myocardium. SCAD is an uncommon condition that predominantly affects young and healthy individuals, particularly women.

Methods

We performed a retrospective review of patients with a known or final diagnosis of SCAD transported for the years the electronic medical record was available (April 2017-November 2023). Given the descriptive and educational nature of this case series for quality improvement, with a small number of transports of interest, comparative statistics were not performed.

Results

We identified 30 patients with a coronary artery dissection undergoing 31 transports. Of these dissections, 2 were iatrogenic and 3 were associated with a concomitant aortic dissection, leaving 26 transports of 25 patients with SCAD. Of these patients, 20 were female (77%), and the median age was 51 (interquartile range 40.3-55.8) years. This skewed younger and more female than all adult transports, at 39.6% female with a median age of 62 (interquartile range 47-73) years. Seven (27%) of the transports involved a patient who was peripartum. In addition, 8 patients (31%) required mechanical circulatory support and 2 were on vasopressors.

Conclusion

In a critical care transport registry, patients with SCAD were younger and more likely to be female than the general adult transport population. More than a quarter were peripartum, and 31% required mechanical circulatory support. Although rare, this is a high-acuity condition that affects a population traditionally considered to be less vulnerable to classic atherosclerotic coronary disease.