Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
EuroIntervention. 2017 Dec 8;13(12):e1454-e1459. doi: 10.4244/EIJ-D-17-00264.
Spontaneous coronary artery dissection (SCAD) is an under-recognised and important cause of myocardial infarction in young women. Recurrent SCAD is frequent but poorly understood. We aimed to explore the clinical and angiographic characteristics, and outcomes of recurrent SCAD.
Patients with SCAD extension or recurrence prospectively followed at Vancouver General Hospital were included in this retrospective study. SCAD diagnosis was confirmed by two experienced cardiologists. Detailed medical history, baseline demographics, angiographic results, and clinical details of index SCAD and recurrent events were recorded. SCAD extension was defined as angiographic extension of a previously dissected coronary segment, and de novo recurrent SCAD was defined as new spontaneous dissection. We identified 43 patients with SCAD recurrence with mean age 48.9±8.4 years; 38/43 were women, and 32/43 had fibromuscular dysplasia. Nine patients had SCAD extension at median time of five (1-19) days, while 34 patients had de novo recurrent SCAD at median time of 1,487 (107- 6,461) days after the index SCAD event. All SCAD extension patients had worsening of the index dissected segment, with 5/9 involving extension to adjacent segments, while all de novo recurrent SCAD patients had new dissections affecting coronary segments distinct from the index dissection.
De novo recurrent SCAD invariably affected new segments distinct from previously dissected segments.
自发性冠状动脉夹层（SCAD）是年轻女性心肌梗死的一个未被充分认识但很重要的原因。SCAD 反复发作较为常见，但目前了解甚少。本研究旨在探讨 SCAD 反复发作的临床和血管造影特征及结局。
本研究为回顾性研究，纳入在温哥华综合医院前瞻性随访的 SCAD 扩展或复发患者。两名经验丰富的心脏病专家确认 SCAD 诊断。记录 SCAD 首发和复发事件的详细病史、基线人口统计学资料、血管造影结果以及临床细节。SCAD 扩展定义为先前夹层冠状动脉节段的血管造影扩展，新发复发性 SCAD 定义为新的自发性夹层。我们共确定了 43 例 SCAD 复发患者，平均年龄为 48.9±8.4 岁；38/43 例为女性，32/43 例存在纤维肌性发育不良。9 例患者在 SCAD 首发后中位 5（1-19）天出现 SCAD 扩展，34 例患者在 SCAD 首发后中位 1,487（107-6,461）天出现新发复发性 SCAD。所有 SCAD 扩展患者的首发夹层节段均有恶化，其中 5/9 例累及邻近节段，而所有新发复发性 SCAD 患者均出现新的、与首发夹层不同的冠状动脉节段夹层。
新发复发性 SCAD 总是累及与先前夹层不同的新节段。
