REVIEW   

Minerva Cardiology and Angiology 2024 June;72(3):251-65

DOI: 10.23736/S2724-5683.22.06195-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Spontaneous coronary artery dissection: review, case report and analysis of COVID-19-related cases

Joseph COSMA ¹ ✉, Alessandro RUSSO ², Valentina FERRADINI ³, Cecilia GOBBI ¹, Vincenzo MALLIA ¹, Andrea ZUFFI ¹, Cédric JORET ¹, Salvatore SACCA ², Ruggiero MANGO ⁴

¹ Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France; ² Department of Cardiology, Ospedale Civile di Mirano, Mirano, Venice, Italy; ³ Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; ⁴ Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy

Spontaneous coronary artery dissection (SCAD) accounts for 1-4% of all acute coronary syndromes (ACS). Since the first description in 1931, our understanding of the disease has evolved; however, its pathophysiology and management are still a matter of debate. SCAD typically occurs in a middle-aged woman with no or few traditional cardiovascular risk factors. Two hypotheses have been proposed to explain the pathophysiology depending on the primary event: an intimal tear in the “inside-out” hypothesis and a spontaneous hemorrhage from the vasa vasorum in the “outside-in” hypothesis. Etiology appears to be multifactorial: different predisposing and precipitating factors have been identified. Coronary angiography is the gold standard for the diagnosis of SCAD. Current recommendations on the treatment of SCAD patients are based on expert opinions: a conservative strategy is preferred in hemodynamically stable SCAD patients, while urgent revascularization should be considered in hemodynamically unstable patients. Eleven cases of SCAD in COVID-19 patients have already been described: although the exact pathophysiological mechanism remains unclear, COVID-19-related SCAD is considered a combination of significant systemic inflammatory response and localized vascular inflammation. We present a literature review of SCAD, and we report an unpublished case of SCAD in a COVID-19 patient.

KEY WORDS: COVID-19; Review; Case reports