Early recurrence of spontaneous coronary artery dissection: potential association with coronary vasospasm and optimal timing for spasm provocation test-a case series

Background Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS). Various factors predispose individuals to SCAD, including coronary vasospasm, which has been identified in some studies as a related factor. Case summary We present a series of three cases of ACS attributed to SCAD. Two cases involved early de novo recurrence potentially related to coronary spasm, and one case involved iatrogenic coronary artery dissection during a spasm provocation test. Discussion High recurrence rates of SCAD within 30 days of the initial event have been observed, although the effectiveness of pharmacologic therapy has not been conclusively established. While the administration of beta-blockers has been associated with a reduced risk of SCAD recurrence, their use may not be desirable in patients with coronary vasospasm. Detailed evaluations may be beneficial for patients where coronary vasospasm is suspected to tailor appropriate treatment strategies. Moreover, given the higher frequency of iatrogenic coronary artery dissection among patients with SCAD, careful consideration is needed to avoid high-risk periods when tests.