急性冠状动脉综合征患者自发性冠状动脉夹层的患病率。
Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome.
作者信息
Nishiguchi Tsuyoshi, Tanaka Atsushi, Ozaki Yuichi, Taruya Akira, Fukuda Shota, Taguchi Haruyuki, Iwaguro Tetsuya, Ueno Satoshi, Okumoto Yasushi, Akasaka Takashi
机构信息
Department of Cardiovascular Medicine, Wakayama Medical University, Japan.
Department of Cardiovascular Medicine, Social Insurance Kinan Hospital, Tanabe, Japan
出版信息
Eur Heart J Acute Cardiovasc Care. 2016 Jun;5(3):263-70. doi: 10.1177/2048872613504310. Epub 2013 Sep 11.
AIMS
Spontaneous coronary artery dissection (SCAD) found typically in young females without classical coronary risk factors is thought to be a very rare cause of acute coronary syndrome (ACS). The prevalence of SCAD in ACS subjects has been unclear, probably due to the nature of coronary angiography. The aim of this study was to use optical coherence tomography (OCT) to investigate the prevalence of SCAD in ACS.
METHODS AND RESULTS
This study consisted of 326 patients with ACS (with or without ST-segment elevation) who underwent OCT to explore the entire culprit artery. According to OCT findings, patients were divided into a SCAD, a plaque rupture (PR), and a non-SCAD/non-PR group. OCT revealed 13 (4.0%) SCADs and 160 (49.1%) plaque ruptures in ACS subjects. The percentage of females versus males was greater in the SCAD group (SCAD: 53.8% vs. PR: 20.0% vs. non-SCAD/non-PR: 23.5%, p=0.02) while no difference was observed in age (SCAD: 67.3±13.3 vs. PR: 66.5±11.1 vs. non-SCAD/non-PR: 67.0±10.5, p=0.90). The prevalence of dyslipidemia (SCAD: 30.8% vs. PR: 63.8% vs. non-SCAD/non-PR: 67.5%, p=0.03) and current smoking (SCAD: 7.7% vs. PR: 57.9% vs. non-SCAD/non-PR: 59.7%, p<0.01) were significantly lower in the SCAD group.
CONCLUSIONS
SCAD is not a rare cause for ACS, especially in females without classical coronary risk factors.
目的
自发性冠状动脉夹层（SCAD）通常在无典型冠状动脉危险因素的年轻女性中发现，被认为是急性冠状动脉综合征（ACS）的一种非常罕见的病因。ACS患者中SCAD的患病率尚不清楚，这可能归因于冠状动脉造影的特性。本研究的目的是使用光学相干断层扫描（OCT）来调查ACS中SCAD的患病率。
方法与结果
本研究纳入了326例ACS患者（有或无ST段抬高），这些患者接受了OCT检查以探查整个罪犯血管。根据OCT检查结果，患者被分为SCAD组、斑块破裂（PR）组和非SCAD/非PR组。OCT显示ACS患者中有13例（4.0%）为SCAD，160例（49.1%）为斑块破裂。SCAD组中女性与男性的比例高于其他两组（SCAD组：53.8%，PR组：20.0%，非SCAD/非PR组：23.5%，p = 0.02），而年龄在三组间无差异（SCAD组：67.3±13.3，PR组：66.5±11.1，非SCAD/非PR组：67.0±10.5，p = 0.90）。SCAD组中血脂异常（SCAD组：30.8%，PR组：63.8%，非SCAD/非PR组：67.5%，p = 0.03）和当前吸烟（SCAD组：7.7%，PR组：57.9%，非SCAD/非PR组：59.7%，p<0.01）的患病率显著低于其他两组。
结论
SCAD是ACS的一个并非罕见病因，尤其是在无典型冠状动脉危险因素的女性中。
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