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Spontaneous dissection of native coronary arteries
  1. R Butler1,
  2. M W I Webster2,
  3. G Davies3,
  4. A Kerr4,
  5. N Bass2,
  6. G Armstrong5,
  7. J T Stewart2,
  8. P Ruygrok2,
  9. J Ormiston2
  1. 1Department of Cardiology, University Hospital of North Staffordshire, Stoke on Trent, UK
  2. 2Auckland Hospital, Auckland, New Zealand
  3. 3Aintree NHS Trust, Liverpool, UK
  4. 4Middlemore Hospital, Auckland, New Zealand
  5. 5North Shore Hospital, Auckland, New Zealand
  1. Correspondence to:
    Dr Robert Butler
    Department of Cardiology, University Hospital of North Staffordshire, Newcastle Road, Stoke on Trent, ST4 6QG;

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Spontaneous coronary artery dissection (SCAD) is relatively rare but occurs most often secondary to catheter tip or balloon injury. SCAD may affect women in the peripartum or early postpartum period.1 Women may dissect at a younger age2 and may dissect the left coronary artery more commonly than men.


We present 13 consecutive cases presenting in Auckland, New Zealand from 1996–2001. The diagnosis was made by angiography in 12 of the patients and at necropsy in one patient. Eleven of the 13 patients were female with a mean age of 44 years (range 25–58 years). There was no excess of traditional risk factors.

On presentation four of the 13 patients were not thought to have an ischaemic pain, but all subsequently had raised cardiac markers and/or ECG changes. One patient presented in the peripartum period and three patients had onset of chest pain after moderate to strenuous exercise.

Angiography demonstrated 22 dissected vessels in total (range 1–3); the vessels involved were the left main stem in two cases, left anterior descending (LAD) in 12 cases, intermediate in one case, circumflex in four cases and right coronary artery in four cases. The mean (SD) length of dissection was 43 (23) mm, which equates to 54 (30%) of the total length of each artery. TIMI (thrombolysis in myocardial infarction) …

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