SPONTANEOUS CORONARY-ARTERY DISSECTION - 8 CASES WITH A FAVORABLE OUTCOME

Spontaneous coronary artery dissection is rare compared with the high incidence of atheromatous coronary artery disease. Eight new clinical and angiographic cases diagnosed between 1984 and 1990 are reported. T he patients were 6 men and 2 women with an average age of 44.1 +/- 10. 7 years. The initial presentation is angina in half the cases, and myo cardial infarction in the other half. Clinical signs and the results o f non-invasive investigations are non-specific. Diagnosis is made by c oronary angiography. The dissection is usually observed on a proximal segment of one of the main coronary arteries. In 5 cases, the disease was confined to a single vessel left anterior descending (3) and right coronary arteries (2). One patient had double vessel disease (left an terior descending and left retroventricular arteries); one patient had triple vessel disease (left anterior descending left circumflex and r ight coronary arteries), and finally, one patient had left main stem d isease extending to the left anterior descending and first diagonal ar teries. There was no aetiological factor in 5 cases whereas 3 had coro nary atherosclerosis. After a period of 25 months all patients are ali ve. Five have drug therapy and 3 have undergone coronary bypass surger y. Six patients are asymptomatic and 2 have mild angina. One patient's coronary circulation has returned to normal. The extension of the ind ication of coronary angiography explains the diagnosis of an increasin g number of spontaneous coronary artery dissection. The condition is s erious but there are more and more long-term survivors as in our serie s.