• Eur Heart J Acute Cardiovasc Care · Oct 2021

    Recognition of acute myocardial infarction caused by spontaneous coronary artery dissection of first septal perforator.

    • Scott W Sharkey, Mesfer Alfadhel, Christina Thaler, David Lin, Meagan Nowariak, João L Cavalcante, Timothy D Henry, and Jacqueline Saw.
    • Division of Cardiovascular Research, Minneapolis Heart Institute and Foundation, 920 East 28th St, Suite 620m, Minneapolis, MN 55407, USA.
    • Eur Heart J Acute Cardiovasc Care. 2021 Oct 27; 10 (8): 933-939.

    Aims Spontaneous coronary artery dissection (SCAD) diagnosis is challenging as angiographic findings are often subtle and differ from coronary atherosclerosis. Herein, we describe characteristics of patients with acute myocardial infarction (MI) caused by first septal perforator (S1) SCAD.Methods And Results Patients were gathered from SCAD registries at Minneapolis Heart Institute and Vancouver General Hospital. First septal perforator SCAD prevalence was 11 of 1490 (0.7%). Among 11 patients, age range was 38-64 years, 9 (82%) were female. Each presented with acute chest pain, troponin elevation, and non-ST-elevation MI diagnosis. Initial electrocardiogram demonstrated ischaemia in 5 (45%); septal wall motion abnormality was present in 4 (36%). Angiographic type 2 SCAD was present in 7 (64%) patients with S1 TIMI 3 flow in 7 (64%) and TIMI 0 flow in 2 (18%). Initial angiographic interpretation failed to recognize S1-SCAD in 6 (55%) patients (no culprit, n = 5, septal embolism, n = 1). First septal perforator SCAD diagnosis was established by review of initial coronary angiogram consequent to cardiovascular magnetic resonance (CMR) demonstrating focal septal late gadolinium enhancement with corresponding oedema (n = 3), occurrence of subsequent SCAD event (n = 2), or second angiogram showing healed S1-SCAD (n = 1). Patients were treated conservatively, each with ejection fraction >50%.Conclusion First septal perforator SCAD events may be overlooked at initial angiography and mis-diagnosed as 'no culprit' MI. First septal perforator SCAD prevalence is likely greater than reported herein and dependent on local expertise and availability of CMR imaging. Spontaneous coronary artery dissection events may occur in intra-myocardial coronary arteries, approaching the resolution limits of invasive coronary angiography.Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.

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