Rigatelli Gianluca, Dell'Avvocata Fabio, Picariello Claudio, Zuin Marco, Giordan Massimo, Roncon Loris
1 Section of Cardiovascular Diagnosis and Endoluminal Interventions, 18674 Rovigo General Hospital , Rovigo, Italy.
2 Department of Cardiology, 18674 Rovigo General Hospital , Rovigo, Italy.
Asian Cardiovasc Thorac Ann. 2018 Feb;26(2):89-93. doi: 10.1177/0218492318757041. Epub 2018 Jan 24.
Background Spontaneous coronary artery dissection is a rare non-atherosclerotic cause of acute coronary syndromes, often underdiagnosed based on standard coronary angiography. Moreover, features, presentation, and intravascular imaging of recurrent spontaneous dissections have not been assessed. Methods Patients with recurrent spontaneous coronary artery dissection, who were admitted to our catheterization laboratory over a 10-year period, were identified. Demographic, clinical, angiographic, and intravascular imaging data were reviewed and analyzed, comparing patients with a single event with those who had a recurrence. Results Over the study period, 31 (0.2%, mean age 48.1 ± 8.8 years, 24 females) of 10,954 patients who underwent coronary angiography experienced a single spontaneous coronary artery dissection, and 6 (0.05%, mean age 49.3 ± 10.1 years, 4 females) experienced recurrent spontaneous coronary artery dissection. No patient suffered more than 2 dissections. Arterial hypertension ( p = 0.004), a string sign measuring >15 mm on angiography, and hematoma on intravascular ultrasound imaging were more frequently observed in patients with recurrent spontaneous coronary artery dissection. Conclusions Hypertension, length of the string sign on angiography, and hematoma on intravascular ultrasound imaging might identify patients at higher risk of recurrent spontaneous coronary artery dissection despite a lifelong dual antiplatelet regimen.
自发性冠状动脉夹层是急性冠状动脉综合征一种罕见的非动脉粥样硬化病因，基于标准冠状动脉造影往往诊断不足。此外，复发性自发性夹层的特征、表现及血管内成像尚未得到评估。方法：确定在10年期间入住我们导管室的复发性自发性冠状动脉夹层患者。回顾并分析人口统计学、临床、血管造影及血管内成像数据，比较单次发病患者与复发患者。结果：在研究期间，10954例行冠状动脉造影的患者中，31例（0.2%，平均年龄48.1±8.8岁，24例女性）发生单次自发性冠状动脉夹层，6例（0.05%，平均年龄49.3±10.1岁，4例女性）发生复发性自发性冠状动脉夹层。无患者发生超过2次夹层。复发性自发性冠状动脉夹层患者更常观察到动脉高血压（p = 0.004）、血管造影上测量>15 mm的线样征以及血管内超声成像上的血肿。结论：尽管采用终身双联抗血小板治疗方案，但高血压、血管造影上线样征的长度以及血管内超声成像上的血肿可能识别出复发性自发性冠状动脉夹层风险较高的患者。
