Prasad Megha, Tweet Marysia S, Hayes Sharonne N, Leng Shuai, Liang Jackson J, Eleid Mackram F, Gulati Rajiv, Vrtiska Terri J
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Am J Cardiol. 2015 Jun 15;115(12):1672-7. doi: 10.1016/j.amjcard.2015.03.011. Epub 2015 Mar 23.
Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome, often occurring in young women. The utility of comprehensive imaging and clinical significance of detected vascular abnormalities have yet to be determined. We hypothesized that extracoronary vascular abnormalities (EVAs) are common in SCAD and aimed to study the prevalence and distribution of these findings. We enrolled 115 patients with confirmed SCAD who were evaluated at the Mayo Clinic SCAD Clinic from February 2010 to May 2014 and prospectively underwent comprehensive computed tomography angiography imaging of the neck, chest, abdomen, and pelvis (SCAD computed tomography angiography protocol, n = 95) or had retrospective review of outside studies (n = 20) including head imaging (n = 40). Follow-up was determined by last clinical visit or study correspondence and included review of recurrent SCAD or myocardial infarction, congestive heart failure, and death. We reported EVAs in 66% of patients with SCAD, most frequently in the abdomen (36%), pelvis (28%), and neck (27%). Only 1 patient had EVA in the chest (aortic dissection and Marfan's). Fibromuscular dysplasia (FMD) (exclusively multifocal) was the most common type of EVA (45%). Vascular abnormalities in those with head imaging included intracranial aneurysms (n = 9) and FMD (n = 3). There were no deaths at median follow-up of 21 months (Q1 to Q3 7.7 to 55). The presence of FMD was not associated with SCAD recurrence (relative risk [RR] 1.2; confidence interval [95% CI] 0.60, 2.5), congestive heart failure (RR 0.66; 95% CI 0.20, 2.3), or myocardial infarction (RR 1.34; 95% CI 0.69, 2.6). In conclusion, EVAs including FMD, dissections, aneurysms, and dilation are common in patients with SCAD and occur in a wide anatomic distribution. The presence of EVAs and/or FMD did not correlate with the risk of subsequent clinical events, but future studies with increased power and longer follow-up will be important to further assess the role of EVAs in patients with SCAD.
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征的一个病因，常发生于年轻女性。全面成像的效用以及所检测到的血管异常的临床意义尚未确定。我们推测冠状动脉外血管异常（EVA）在SCAD中很常见，并旨在研究这些发现的患病率和分布情况。我们纳入了115例确诊为SCAD的患者，这些患者于2010年2月至2014年5月在梅奥诊所SCAD门诊接受评估，并前瞻性地接受了颈部、胸部、腹部和骨盆的全面计算机断层扫描血管造影成像（SCAD计算机断层扫描血管造影方案，n = 95），或对外部研究（n = 20）进行回顾性分析，其中包括头部成像（n = 40）。随访通过最后一次临床就诊或研究通信确定，包括复发性SCAD或心肌梗死、充血性心力衰竭和死亡情况的审查。我们报告在66%的SCAD患者中存在EVA，最常见于腹部（36%）、骨盆（28%）和颈部（27%）。只有1例患者胸部存在EVA（主动脉夹层和马凡综合征）。纤维肌发育不良（FMD）（仅为多灶性）是最常见的EVA类型（45%）。进行头部成像的患者中的血管异常包括颅内动脉瘤（n = 9）和FMD（n = 3）。在21个月的中位随访期（第一四分位数至第三四分位数为7.7至55）内无死亡病例。FMD的存在与SCAD复发（相对风险[RR] 1.2；置信区间[95% CI] 0.60，2.5）、充血性心力衰竭（RR 0.66；95% CI 0.20，2.3）或心肌梗死（RR 1.34；95% CI 0.69，2.6）均无关。总之，包括FMD、夹层、动脉瘤和扩张在内的EVA在SCAD患者中很常见，且发生部位解剖分布广泛。EVA和/或FMD的存在与后续临床事件的风险无关，但未来进行更有力度且随访时间更长的研究对于进一步评估EVA在SCAD患者中的作用将很重要。
