Myocardial infarction due to spontaneous coronary artery dissection: a retrospective diagnosis. A case report

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is characterized by the absence of stenotic or occlusive lesions in the infarct-related artery on coronary angiography. MINOCA accounts for 6-15% of all MI cases and carries an annual mortality of up to 3,5%. The etiology of this syndrome is heterogeneous and includes atherosclerotic and non-atherosclerotic mechanisms, coronary vasospasm, microvascular dysfunction, thromboembolism, and spontaneous coronary artery dissection (SCAD). SCAD is one of the leading causes of MINOCA in young women and may present with intramural hematoma formation and transient luminal narrowing, often requiring intravascular imaging for an accurate diagnosis. This article describes a case of MINOCA caused by SCAD in a 34-year-old female patient, confirmed by comprehensive laboratory and imaging evaluation including intravascular techniques.

1. Pasupathy S, Air T, Dreyer RP, et al. Systematic Review of Pa­tients Presenting With Suspected Myocardial Infarction and Nonob­stru­ctive Coronary Arteries. Circulation. 2015;131(10):861-70. doi:10.1161/CIRCULATIONAHA.114.011201.

2. Parwani P, Kang N, Safaeipour M, et al. Contemporary Diagnosis and Management of Patients with MINOCA. Curr Cardiol Rep. 2023;25(6):561-70. doi:10.1007/s11886-023-01874-x.

3. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018;138(20). doi:10.1161/CIR.0000000000000617.

4. Bainey KR, Welsh RC, Alemayehu W, et al. Population-­level inci­dence and outcomes of myocardial infarction with non-ob­struc­tive coronary arteries (MINOCA): Insights from the Alberta con­tem­porary acute coronary syndrome patients invasive treatment strategies (COAPT) study. Int J Cardiol. 2018;264:12-7. doi:10.1016/j.ijcard.2018.04.004.

5. Niccoli G, Scalone G, Crea F. Acute myocardial infarction with no ob­structive coronary atherosclerosis: mechanisms and manage­ment. Eur Heart J. 2015;36(8):475-81. doi:10.1093/eurheartj/ehu469.

6. Saw J, Humphries K, Aymong E, et al. Spontaneous Coronary Artery Dissection. J Am Coll Cardiol. 2017;70(9):1148-58. doi:10.1016/j.jacc.2017.06.053.

7. Britel D, Nikièma S, Massimbo D, et al. Spontaneous coronary artery dissection (SCAD): a case report. Ann Med Surg. 2023; 85(1):32-6. doi:10.1097/MS9.0000000000000095.

8. Hayes SN, Kim ESH, Saw J, et al. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation. 2018;137(19). doi:10.1161/CIR.0000000000000564.

9. Ciliberti G, Westaby J, Papadakis M, et al. Coronary Artery Dissec­tion and Myocardial Infarction With Nonobstructed Coronary Ar­te­ries: Insights From a UK Nationwide Autopsy-­Based Re­gist­ry–Brief Report. ATVB. 2023;43(5):787-92. doi:10.1161/ATVBAHA.122.318401.

10. Tweet MS, Hayes SN, Codsi E, et al. Spontaneous Coronary Ar­tery Dissection Associated With Pregnancy. J Am Coll Cardiol. 2017;70(4):426-35. doi:10.1016/j.jacc.2017.05.055.

11. Adlam D, Alfonso F, Maas A, et al. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018;39(36):3353-68. doi:10.1093/eurheartj/ehy080.

12. Zainobidinov ShSh, Khelimsky DA, Baranov AA, et al. Modern aspects of diagnosis and treatment of patients with spontaneous co­ronary artery dissection. Cardiovascular Therapy and Pre­ven­tion. 2022;21(8):3193. (In Russ.) doi:10.15829/1728-8800-2022-3193.

13. Mahmood MM, Austin D. IVUS and OCT guided primary per­cu­taneous coronary intervention for spontaneous coronary artery dis­section with bioresorbable vascular scaffolds. Cardiovasc Revasc Med. 2017;18(1):53-7. doi:10.1016/j.carrev.2016.09.005.

14. Khattab E, Karelas D, Pallas T, et al. MINOCA: A Pathophysio­lo­gical Approach of Diagnosis and Treatment-­A Narrative Re­view. Biomedicines. 2024;12(11):2457. doi:10.3390/biomedicines12112457.

15. Mori R, Macaya F, Escaned J, et al. Endothelial Dysfunction and Epicardial Coronary Spasm in a Woman With Previous Spon­taneous Coronary Artery Dissection. JACC Cardiovasc Interv. 2020; 13(24):e219-20. doi:10.1016/j.jcin.2020.09.036.

16. Mahmoudi A, Katsiki N, Vrablik M, et al. Pleiotropic Effects of Statins: Focus on Inflammation, Oxidative Stress and Im­mu­no­modulation (Part I). Curr Atheroscler Rep. 2026;28(1):8. doi:10.1007/s11883-025-01386-9.