Why the study?
Spontaneous coronary artery dissection is an uncommon cause of MINOCA whose luminal narrowing may improve before or go unappreciated on coronary angiography.
This case report highlights that a coronary spasm provocation test in a patient with prior MINOCA and normal angiograms can induce recurrent chest pain and reveal an underlying or iatrogenic spontaneous coronary artery dissection (SCAD).
Spasm provocation testing warrants caution in MINOCA; leaves open the need for safety data before routine use.
Spontaneous coronary artery dissection (SCAD) is an uncommon cause of MINOCA. The spontaneous development of an intramural hematoma narrows the true lumen. This narrowing may improve prior to coronary angiography, or may not be appreciated, leading to a diagnosis of MINOCA. We reported the case of a 50-years old woman, active smoker, with a previous history of MINOCA [septo-apical MI on Cardiac Magnetic Resonance (CMR) imaging] who was referred to our institution for recurrent chest pain. Two coronary angiograms, which were previously performed, were considered as normal. We decided to repeat coronary angiography in order to perform a spasm provocation test. Unfortunately, this test during this third examination induced recurrent chest pain and revealed a SCAD.
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Gerbaud et al. (2026) studied this question.
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