Large Spontaneous Coronary Artery Dissection Presenting as Acute STEMI - Is Intervention the Only Answer?

Spontaneous coronary artery dissection (SCAD) is a rare but an important cause of ST elevation myocardial infarction (STEMI) in young patients. Here, we report case of a 32-year-old male presenting as acute anterior wall STEMI for which was thrombolysed. Coronary angiogram revealed spiral luminal filling defects with extensive contrast staining of proximal left anterior descending artery involving diagonal branch representing Type D dissection. As patient refused any intervention, he was managed conservatively. He presented with unstable angina 6-weeks later. Repeat angiogram revealed complete healing of dissection along with borderline lesion. As his treadmill test was negative for exercise induced myocardial ischaemia, he was managed conservatively. This case highlights that beside intervention, patients with high grade dissection may respond to conservative management.