ST-segment elevationmyocardial infarction could be the primary presentation of acute aortic dissection

Article history: Received 13 January 2017 Received in revised form 5 May 2017 Accepted 10 May 2017 Available online xxxx Background: Stanford type A aortic dissection (TAAD) may lead to coronary artery occlusion and malfunction. However, TAADmanifesting as acute ST-segment elevation myocardial infarction (STEMI) has not been studied. In the present study, we reported 8 TAAD cases with STEMI as the primary presentation, and analyzed their clinical characteristics and outcome. Methods: The records were reviewed for patients admitted to the large comprehensive university hospital for PCI due to STEMI from January 1, 2002 to January 1, 2017. Results: The incidence of STEMI secondary to TAAD in our center was 0.51% (8/1,576). A total of 5 patients underwent urgent coronary angiography (CAG) without awareness of TAAD. Compression at the ostium of right coronary artery (RCA) was found in 2 patients, dissected flap of RCA in 1 patient, and heterogeneous filling and false lumen in RCA in 1 patient. Three of these 5 patients received surgery and survived. One patient accepted urgent RCA stenting because of cardiogenic shock and died after refusal of surgical therapy and failure ofmedical treatment. Another 2 patients received thrombolytic therapy died prior to CAG. Thus, the total in-hospital mortality was 37.5% (3/8). Conclusions: TAAD presenting as STEMI was a rare condition that predominantly involved RCA. A quick and correct clinical diagnosis of STEMI caused by TAAD prior to invasive procedure would be important. Urgent CAG without awareness of TAAD could provide important information for a timely diagnosis. High level of suspicion and awareness is the key to establishing the diagnosis and achieving optimal clinical outcome. © 2017 Published by Elsevier Inc.