Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible mechanisms.
A-SCAD
ACS
COVID-19
Case report
Coronary artery dissection
PCI
SCAD
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
15
04
2020
revised:
22
04
2020
accepted:
28
04
2020
entrez:
22
10
2020
pubmed:
23
10
2020
medline:
23
10
2020
Statut:
epublish
Résumé
Spontaneous coronary artery dissection (SCAD) may be atherosclerotic (A-SCAD) or non-atherosclerotic (NA-SCAD) in origin. Contemporary usage of the term 'SCAD' is typically synonymous with NA-SCAD. COVID-19 could induce a vascular inflammation localized in the coronary adventitia and periadventitial fat and contribute to the development of an A-SCAD of a vulnerable plaque in a susceptible patient. In this report we describe a case of a COVID-19 patient with past cardiac history of CAD who was admitted for acute coronary syndrome (ACS). Coronary angiography demonstrated the culprit lesion in the proximal LAD that presented with a very complex and unusual morphology, indicative of an A-SCAD. The diagnosis of A-SCAD was supported by the presence of a mild stenosis in the same coronary segment in the last angiogram performed 3 years previously. He was successfully treated by PCI, had a favourable course of the COVID-19 with no symptoms of pneumonia, and was discharged from the hospital after two negative tests for SARS-CoV-2. A higher index of suspicion of A-SCAD is needed in patients with suspected or confirmed COVID-19 presenting with ACS. The proposed approach with 'thrombolysis first' for treating STEMI patients with suspected or confirmed COVID-19 infection could be unsafe in the case of underlying A-SCAD.
Sections du résumé
BACKGROUND
BACKGROUND
Spontaneous coronary artery dissection (SCAD) may be atherosclerotic (A-SCAD) or non-atherosclerotic (NA-SCAD) in origin. Contemporary usage of the term 'SCAD' is typically synonymous with NA-SCAD. COVID-19 could induce a vascular inflammation localized in the coronary adventitia and periadventitial fat and contribute to the development of an A-SCAD of a vulnerable plaque in a susceptible patient.
CASE SUMMARY
METHODS
In this report we describe a case of a COVID-19 patient with past cardiac history of CAD who was admitted for acute coronary syndrome (ACS). Coronary angiography demonstrated the culprit lesion in the proximal LAD that presented with a very complex and unusual morphology, indicative of an A-SCAD. The diagnosis of A-SCAD was supported by the presence of a mild stenosis in the same coronary segment in the last angiogram performed 3 years previously. He was successfully treated by PCI, had a favourable course of the COVID-19 with no symptoms of pneumonia, and was discharged from the hospital after two negative tests for SARS-CoV-2.
DISCUSSION
CONCLUSIONS
A higher index of suspicion of A-SCAD is needed in patients with suspected or confirmed COVID-19 presenting with ACS. The proposed approach with 'thrombolysis first' for treating STEMI patients with suspected or confirmed COVID-19 infection could be unsafe in the case of underlying A-SCAD.
Identifiants
pubmed: 33089040
doi: 10.1093/ehjcr/ytaa133
pii: ytaa133
pmc: PMC7239234
doi:
Types de publication
Case Reports
Langues
eng
Pagination
1-6Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
N Engl J Med. 2018 Jan 25;378(4):345-353
pubmed: 29365305
Eur Heart J. 2020 May 14;41(19):1791-1794
pubmed: 32232396
Eur Heart J. 2007 May;28(10):1205-10
pubmed: 17440221
Arch Pathol Lab Med. 2007 Mar;131(3):481-7
pubmed: 17516753
JACC Cardiovasc Interv. 2020 Jun 22;13(12):e107-e108
pubmed: 32553344
JAMA Cardiol. 2020 Jul 1;5(7):831-840
pubmed: 32219363
Eur Heart J. 2018 Sep 21;39(36):3353-3368
pubmed: 29481627
J Invasive Cardiol. 2010 May;22(5):222-8
pubmed: 20440039
Am J Cardiol. 1986 Nov 1;58(10):937-9
pubmed: 3776849
Arterioscler Thromb Vasc Biol. 2011 Dec;31(12):2929-37
pubmed: 21960562
Eur J Cardiothorac Surg. 2001 Sep;20(3):573-6
pubmed: 11509281
Lancet Infect Dis. 2010 Feb;10(2):83-92
pubmed: 20113977
Circulation. 1994 Aug;90(2):775-8
pubmed: 8044947
Tex Heart Inst J. 2007;34(1):11-8
pubmed: 17420787