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Background— Spontaneous coronary artery dissection (SCAD) is an acute coronary event of uncertain origin. Clinical features and prognosis remain insufficiently characterized. Methods and Results— A retrospective single-center cohort study identified 87 patients with angiographically confirmed SCAD. Incidence, clinical characteristics, treatment modalities, in-hospital outcomes, and long-term risk of SCAD recurrence or major adverse cardiac events were evaluated. Mean age was 42.6 years; 82% were female. Extreme exertion at SCAD onset was more frequent in men (7 of 16 versus 2 of 71; P Conclusions— SCAD affects a young, predominantly female population, frequently presenting as ST-elevation myocardial infarction. Although in-hospital mortality is low regardless of initial treatment, percutaneous coronary intervention is associated with high rates of complication. Risks of SCAD recurrence and major adverse cardiac events in the long term emphasize the need for close follow-up. Fibromuscular dysplasia is a novel association and potentially causative factor.

Melanoma is a neoplasm notorious for its dismal prognosis and its propensity for cardiac involvement. Roughly a third of patients diagnosed with primary cutaneous melanoma develop pulmonary, osseous, cerebral or hepatic metastatic disease ante mortem. In contrast, ante mortem cardiac involvement is reported in 2% of cases but in over 50% of patients with metastatic melanoma postmortem.1 Cardiac involvement is usually multifocal, believed to disseminate hematogenously and commonly involves the epicardium, myocardium, pericardium or may present as intracavitary tumors.2 The surgical management of cardiac tumors can be challenging, particularly when they occur in locations that make surgical access and resection technically difficult. Recent refinements in myocardial perfusion imaging, computerized tomography, and cardiac magnetic resonance imaging help provide precise information on anatomic location, vascularity, and tumor extension into adjacent mediastinal structures.3 Early detection of cardiac melanoma has important therapeutic and prognostic …