Convalescent Spontaneous Coronary Artery Dissection With Elevated Pericoronary Fat Attenuation Index

BACKGROUND: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined by the presence of the universal acute myocardial infarction criteria in the absence of obstructive disease on angiography. Multimodal imaging can be invaluable in determining the underlying etiology of MINOCA. Spontaneous coronary artery dissection (SCAD) is among the most common etiologies. CASE SUMMARY: This report describes a case of unrecognized/asymptomatic myocardial infarction due to SCAD in an active 62-year-old woman whose care was facilitated by comprehensive evaluation of MINOCA. DISCUSSION: Pericoronary fat attenuation indexing (FAI) has yet to be extensively studied in the setting of MINOCA. Initial studies suggest elevated pericoronary FAI in MINOCA and SCAD, providing introductory evidence that vascular insult increases coronary artery inflammation appreciably via pericoronary FAI. TAKE-HOME MESSAGE: This case report further substantiates that claim and demonstrates that coronary computed tomography angiography with pericoronary FAI may prove useful in working up MINOCA.