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It is a potentially fatal disorder that predominantly (&amp;gt;90% of cases) affects women, who are about 20 years younger (age 45\u201352 years) than those presenting with an acute coronary syndrome due to atherosclerotic coronary artery disease, and is the commonest cause of myocardial infarction associated with pregnancy. With the advent of improved coronary artery imaging modalities, including invasive coronary angiography, intravascular ultrasonography (IVUS), and optical coherence tomography (OCT), spontaneous coronary artery dissection is being increasingly diagnosed. It is typically due to a spontaneous bleed in the tunica media of an epicardial coronary artery, with or without an intimal tear, that results in an intramural haematoma; the latter, in turn causing a separation or dissection of the lamellae formed by the layers of smooth muscle cells of the tunica media, which can propagate longitudinally. Although coronary artery dissection can be due to atherosclerotic disease that may, in fact, present spontaneously, or to trauma, or guidewire-induced intimal injury, the understanding that the entity now known as spontaneous coronary artery dissection is an idiopathic disorder that is not associated with atherosclerosis or trauma, and is not iatrogenic, is one that has emerged only relatively recently (last 10\u201315 years). This raises the question, what is the provenance of spontaneous coronary artery dissection as it is now defined and understood? Here, this issue is addressed by a detailed consideration of the medical literature from 1800.<\/jats:p>","DOI":"10.1093\/ehjopen\/oeag066","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T11:40:57Z","timestamp":1775821257000},"source":"Crossref","is-referenced-by-count":0,"title":["On the provenance of spontaneous coronary artery dissection"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1042-2587","authenticated-orcid":false,"given":"Robert M","family":"Graham","sequence":"first","affiliation":[{"name":"Victor Chang Cardiac Research Institute , 405 Liverpool Street, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"School of Clinical Medicine, St Vincent\u2019s Healthcare Clinical Campus, Faculty of Medicine and Health, University of NSW , 390 Victoria Street, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"Cardiology Department, John Hunter Hospital , Lookout Road, New Lambton Heights, NSW 2305 ,","place":["Australia"]},{"name":"Cardiology Department, St Vincent\u2019s Hospital , 390 Victoria Street, Darlinghurst, NSW 2010 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3129-362X","authenticated-orcid":false,"given":"Sharonne N","family":"Hayes","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science , 200 1st St SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"McGrath-Cadell","sequence":"additional","affiliation":[{"name":"Victor Chang Cardiac Research Institute , 405 Liverpool Street, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"School of Clinical Medicine, St Vincent\u2019s Healthcare Clinical Campus, Faculty of Medicine and Health, University of NSW , 390 Victoria Street, Darlinghurst, NSW 2010 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siiri E","family":"Iismaa","sequence":"additional","affiliation":[{"name":"Victor Chang Cardiac Research Institute , 405 Liverpool Street, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"School of Clinical Medicine, St Vincent\u2019s Healthcare Clinical Campus, Faculty of Medicine and Health, University of NSW , 390 Victoria Street, Darlinghurst, NSW 2010 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7084-6736","authenticated-orcid":false,"given":"Eleni","family":"Giannoulatou","sequence":"additional","affiliation":[{"name":"Victor Chang Cardiac Research Institute , 405 Liverpool Street, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"School of Clinical Medicine, St Vincent\u2019s Healthcare Clinical Campus, Faculty of Medicine and Health, University of NSW , 390 Victoria Street, Darlinghurst, NSW 2010 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason C","family":"Kovacic","sequence":"additional","affiliation":[{"name":"Victor Chang Cardiac Research Institute , 405 Liverpool Street, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"School of Clinical Medicine, St Vincent\u2019s Healthcare Clinical Campus, Faculty of Medicine and Health, University of NSW , 390 Victoria Street, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"Cardiology Department, St Vincent\u2019s Hospital , 390 Victoria Street, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"Cardiovascular Institute, Icahn School of Medicine at Mount Sinai , 1 Gustave L. Levy Place, NewYork, NY 10029 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"2026061309334794900_oeag066-B1","first-page":"667","article-title":"Dissecting aneurysm of coronary artery in a woman aged 42:rupture","volume":"1","author":"Pretty","year":"1931","journal-title":"Br Med J"},{"key":"2026061309334794900_oeag066-B2"},{"key":"2026061309334794900_oeag066-B3","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s10554-005-9036-9","article-title":"Large atherosclerotic plaque-related severe right coronary artery dissection during coronary angiography","volume":"22","author":"Gur","year":"2006","journal-title":"Int J Cardiovasc Imag"},{"key":"2026061309334794900_oeag066-B4"},{"key":"2026061309334794900_oeag066-B5","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1007\/s12024-017-9845-x","article-title":"Spontaneous coronary artery dissection","volume":"13","author":"Byard","year":"2017","journal-title":"Forensic Sci Med Pathol"},{"key":"2026061309334794900_oeag066-B6","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1056\/NEJM198401193100307","article-title":"Hypothesis: vasa vasorum and neovascularization of human coronary arteries. A possible role in the pathophysiology of atherosclerosis","volume":"310","author":"Barger","year":"1984","journal-title":"N Engl J Med"},{"key":"2026061309334794900_oeag066-B7","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.stemcr.2017.04.028","article-title":"Classification and functional characterization of vasa vasorum-associated perivascular progenitor cells in human aorta","volume":"9","author":"Billaud","year":"2017","journal-title":"Stem Cell Rept"},{"key":"2026061309334794900_oeag066-B8","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1136\/pgmj.69.818.940","article-title":"Spontaneous coronary artery dissection: a report of three cases and review of the literature","volume":"69","author":"Kearney","year":"1993","journal-title":"Postgrad Med J"},{"key":"2026061309334794900_oeag066-B9","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1038\/s41588-023-01410-1","article-title":"Genome-wide association meta-analysis of spontaneous coronary artery dissection identifies risk variants and genes related to artery integrity and tissue-mediated coagulation","volume":"55","author":"Adlam","year":"2023","journal-title":"Nat Genet"},{"key":"2026061309334794900_oeag066-B10","doi-asserted-by":"crossref","first-page":"e523","DOI":"10.1161\/CIR.0000000000000564","article-title":"Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association","volume":"137","author":"Hayes","year":"2018","journal-title":"Circulation"},{"key":"2026061309334794900_oeag066-B11","doi-asserted-by":"crossref","first-page":"114 8","DOI":"10.1016\/j.jacc.2017.06.053","article-title":"Spontaneous coronary artery dissection. 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