Spontaneous coronary artery dissection in systemic lupus erythematosus: case-based review
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Patients with systemic lupus erythematosus (SLE) present an increased prevalence of coronary heart disease. The majority of cases of acute coronary syndrome (ACS) in patients with SLE are due to atherosclerosis. Less common causes include thrombosis of an angiographically normal coronary artery and coronary vasculitis. Spontaneous coronary artery dissection (SCAD) is a rare cause of ACS in these patients. We report the case of a 53-year-old female diagnosed of SLE presenting with an ACS caused by SCAD. She was treated medically and her clinical course was favorable. A literature search identified seven additional cases of SCAD associated with SLE. The main clinical features found in these reports are revised. ACS caused by SCAD in SLE patients is a condition likely under-reported in literature. SCAD should be suspected in patients with SLE and ACS, especially in younger women without evident cardiovascular risk factors. An early accurate diagnosis of SCAD is key to provide specific treatment, which differs from that of usual atherosclerotic ACS.
KeywordsSystemic lupus erythematosus Coronary artery disease Myocardial infarction Spontaneous coronary artery dissection
The authors wish to thank the Research Unit of Hospital Universitario de Burgos (HUBU) for their help in the preparation of the English version of the manuscript.
The case was diagnosed and followed up by SMG, BAL and JMGG. BAL and LAR conceived and planned the study. BAL and LAR wrote the manuscript. Literature data were searched and analyzed by all the authors. The final version was read, corrected and approved by all the authors.
The authors received no financial support for the research, authorship, and/or publication of this article.
Compliance with ethical standards
Conflict of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
All the procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All the authors fulfilled the ICMJE authorship criteria.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
- 1.Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE et al (2018) Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation 137(19):e523–e557. https://doi.org/10.1161/CIR.0000000000000564 CrossRefGoogle Scholar
- 5.Aldoboni AH, Hamza EA, Majdi K, Ngibzadhe M, Palasaidi S, Moayed DA (2002) Spontaneous dissection of coronary artery treated by primary stenting as the first presentation of systemic lupus erythematosus. J Invasive Cardiol 14(11):694–696Google Scholar
- 6.Sharma AK, Farb A, Maniar P, Ajani AE, Castagna M, Virmani R, Suddath W, Lindsay J (2003) Spontaneous coronary artery dissection in a patient with systemic lupus erythematosus. Hawaii Med J 62(11):248–253Google Scholar
- 12.Kavandi H, Golmohammadi A, Sadeghi R, Hajizadeh R (2018) Coronary artery dissection in a woman with previous systemic lupus erythematosus using oral contraceptive pills. Acta Med Iran 56(12):815–817Google Scholar
- 13.Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger TA Jr, Jansen-McWilliams L, D’Agostino RB, Kuller LH (1997) Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 145(5):408–415CrossRefGoogle Scholar
- 20.Haque S, Gordon C, Isenberg D, Rahman A, Lanyon P, Bell A, Emery P, McHugh N, Teh LS, Scott DG, Akil M, Naz S, Andrews J, Griffiths B, Harris H, Youssef H, McLaren J, Toescu V, Devakumar V, Teir J, Bruce IN (2010) Risk factors for clinical coronary heart disease in systemic lupus erythematosus: the lupus and atherosclerosis evaluation of risk (LASER) study. J Rheumatol 37(2):322–329. https://doi.org/10.3899/jrheum.090306 CrossRefGoogle Scholar
- 21.Reiss AB, Anwar K, Merrill JT, Chan ES, Awadallah NW, Cronstein BN, Michael Belmont H, Belilos E, Rosenblum G, Belostocki K, Bonetti L, Hasneen K, Carsons SE (2010) Plasma from systemic lupus patients compromises cholesterol homeostasis: a potential mechanism linking autoimmunity to atherosclerotic cardiovascular disease. Rheumatol Int 30(5):591–598. https://doi.org/10.1007/s00296-009-1020-6 CrossRefGoogle Scholar
- 30.Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, Gersh BJ, Khambatta S, Best PJ, Rihal CS, Gulati R (2012) Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation 126(5):579–588. https://doi.org/10.1161/CIRCULATIONAHA.112.105718 CrossRefGoogle Scholar
- 32.Roura G, Ariza-Solé A, Rodriguez-Caballero IF, Gomez-Lara J, Ferreiro JL, Romaguera R, Teruel L, de Albert M, Gomez-Hospital JA, Cequier A (2016) Noninvasive follow-up of patients with spontaneous coronary artery dissection with CT angiography. JACC Cardiovasc Imaging 9(7):896–897. https://doi.org/10.1016/j.jcmg.2015.06.011 CrossRefGoogle Scholar