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Spontaneous coronary artery dissection in systemic lupus erythematosus: case-based review

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Abstract

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.

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Acknowledgements

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.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors

Contributions

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.

Corresponding author

Correspondence to Bonifacio Álvarez-Lario.

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The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

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.

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Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

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Álvarez-Lario, B., Álvarez-Roy, L., Mayordomo-Gómez, S. et al. Spontaneous coronary artery dissection in systemic lupus erythematosus: case-based review. Rheumatol Int 39, 1821–1827 (2019). https://doi.org/10.1007/s00296-019-04351-3

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