Department of Emergency Medicine, Maine Medical Center, Portland, ME 04102, USA.
J Am Board Fam Med. 2013 Jan-Feb;26(1):82-9. doi: 10.3122/jabfm.2013.01.120019.
The objective of this study was to determine whether spontaneous peripartum coronary artery dissection (SPCAD) is a cause of acute myocardial infarction in women.
Patients with SPCAD reported in the recent literature were analyzed to elucidate the clinically relevant characteristics of this condition.
Forty-seven cases of SPCAD are described. Patient characteristics include the following: mean age, 33.5 ± 5.2 years; gravity, 2.7 (95% confidence interval, 1.8-3.5); mean gestational age if prepartum, 32.5 ± 4.2 weeks (range, 23-36 weeks); and mean onset if postpartum, 22.9 ± 26.1 days (range, 3-90 days). Only 17 patients (36%) reported a cardiac risk factor, with the most frequent being smoking. All presented with characteristic ischemic pain; 25% of patients were hemodynamically unstable; and 81% of initial electrocardiograms demonstrated ST-elevation myocardial infarctions. The left coronary artery system was involved 81% of the time. Thirty percent of patients were managed conservatively or with thrombolytic therapy, whereas 34% received emergent percutaneous cardiac intervention and 36% required bypass surgery. There were no maternal deaths. Long-term follow-up revealed good cardiac function in the majority of patients, although 3 women required heart transplantation.
SPCAD can occur weeks before or after delivery and should be considered in women presenting during the peripartum period with acute chest pain.
本研究旨在探讨自发性围产期冠状动脉夹层（SPCAD）是否是导致女性急性心肌梗死的原因。
分析近期文献中报道的 SPCAD 患者，以阐明该疾病的临床相关特征。
描述了 47 例 SPCAD 病例。患者特征包括：平均年龄 33.5±5.2 岁；病情严重程度 2.7（95%置信区间，1.8-3.5）；如果是产前，平均孕龄为 32.5±4.2 周（范围 23-36 周）；如果是产后，平均发病时间为 22.9±26.1 天（范围 3-90 天）。只有 17 例患者（36%）报告有心脏危险因素，最常见的是吸烟。所有患者均表现出特征性的缺血性疼痛；25%的患者血流动力学不稳定；81%的初始心电图显示 ST 段抬高型心肌梗死。左冠状动脉系统受累占 81%。30%的患者接受保守治疗或溶栓治疗，34%接受紧急经皮冠状动脉介入治疗，36%需要旁路手术。无孕产妇死亡。长期随访发现大多数患者心功能良好，但 3 名女性需要心脏移植。
SPCAD 可在分娩前数周或分娩后发生，应考虑在围产期出现急性胸痛的女性中。
