Cade Jamil R, Szarf Gilberto, de Siqueira Maria Eduarda M, Chaves Áurea, Andréa Júlio C M, Figueira Hélio R, Gomes Manuel M, Freitas Bárbara P, Filgueiras Medeiros Juliana, Dos Santos Márcio Ricardo, Fiorotto Walter B, Daige Augusto, Gonçalves Rosaly, Cantarelli Marcelo, Alves Cláudia Maria Rodrigues, Echenique Leandro, de Brito Fábio S, Perin Marco A, Born Daniel, Hecht Harvey, Caixeta Adriano
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Hospital Israelita Albert Einstein, São Paulo, Brazil.
Eur Heart J Cardiovasc Imaging. 2017 Jan;18(1):54-61. doi: 10.1093/ehjci/jew021. Epub 2016 Feb 28.
We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes.
Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient.
In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.
我们旨在呈现一系列13例妊娠相关自发性冠状动脉夹层（P-SCAD）病例，包括其血管造影和多模态影像学表现、急性期治疗及预后。
2005年至2015年期间，从11家三级医院的数据库中收集了13例P-SCAD病例。平均年龄为33.8±3.7岁；大多数患者无冠状动脉疾病危险因素，且多数为经产妇。12例患者的P-SCAD发生在产褥期，中位时间为10天。只有1例患者在妊娠第37周出现P-SCAD，她是该系列中唯一死亡的患者。6例（46%）患者表现为ST段抬高型急性心肌梗死（STEMI），6例（46%）表现为非STEMI，1例表现为不稳定型心绞痛；三分之一的女性发生心源性休克。12例患者中，夹层累及左前降支或回旋支动脉，6例患者延伸至左主干冠状动脉。血管内超声或光学相干断层扫描在46%的病例中有助于确诊并指导治疗。7例女性接受临床治疗；5例患者接受了经皮冠状动脉介入治疗，1例患者接受了冠状动脉旁路移植术。
在这13例P-SCAD病例中，临床表现通常包括急性心肌梗死和心源性休克。多支血管夹层以及左冠状动脉和左主干冠状动脉受累非常普遍。临床医生必须了解P-SCAD的血管造影表现，以便对这些高危患者进行及时诊断和管理。
