Multivessel Spontaneous Coronary Artery Dissection Linked to Antiphospholipid Syndrome.

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.