Shah Syed Raza, Alweis Richard
From the Department of Medicine, North Florida Regional Medical Center, University of Central Florida (Gainesville), Gainesville, FL.
DIO/Associate CMO for Medical Education, Department of Medicine- Rochester Regional Health System, Rochester, NY.
Cardiol Rev. 2018 Sep/Oct;26(5):274-276. doi: 10.1097/CRD.0000000000000186.
Acute coronary artery dissection is a rare, complex disease occurring particularly in young women without traditional cardiovascular risk factors. The pathophysiology and treatment are different from acute coronary syndrome caused by plaque rupture or erosion. Its clinical presentation may vary from unstable angina to sudden cardiac death. Hence, early detection is crucial to manage the dissection and reduce the mortality and morbidity rates. Most coronary dissections will heal spontaneously, and conservative treatment is recommended for uncomplicated cases. In the acute phase, primary percutaneous coronary intervention remains the reperfusion strategy of choice; however, in small- and medium-sized arteries with normalized blood flow, conservative treatment is beneficial. Medical therapy should be tailored to the individual depending on the underlying severity of the condition. Percutaneous coronary intervention should be performed by experienced operators, with the use of intravascular imaging, and preferably with on-site surgical back-up due to the increased risk of complications. The prognosis is favorable; however, patients have a high risk of recurrent dissections in other arteries several weeks after the first event, suggesting a general weakness of the arteries. In the recent past, optical coherence tomography has played an important role in the diagnosis of acute coronary artery dissection; however, its therapeutic potential is underestimated. We recommend that long-term clinical trials should be conducted to fully determine the long-term mortality and morbidity rates of these patients.
急性冠状动脉夹层是一种罕见的复杂疾病，尤其多见于无传统心血管危险因素的年轻女性。其病理生理学和治疗方法与由斑块破裂或糜烂引起的急性冠状动脉综合征不同。其临床表现可能从不稳定型心绞痛到心源性猝死不等。因此，早期检测对于处理夹层并降低死亡率和发病率至关重要。大多数冠状动脉夹层会自行愈合，对于无并发症的病例建议采取保守治疗。在急性期，直接经皮冠状动脉介入治疗仍是首选的再灌注策略；然而，在血流已恢复正常的中小动脉中，保守治疗是有益的。应根据病情的潜在严重程度对个体进行个体化药物治疗。经皮冠状动脉介入治疗应由经验丰富的操作人员进行，使用血管内成像技术，并且由于并发症风险增加，最好有现场手术支持。预后良好；然而，患者在首次事件发生数周后，其他动脉发生夹层复发的风险较高，提示动脉存在普遍薄弱的情况。近年来，光学相干断层扫描在急性冠状动脉夹层的诊断中发挥了重要作用；然而，其治疗潜力被低估了。我们建议应开展长期临床试验，以全面确定这些患者的长期死亡率和发病率。
