Circulation. 2018 May 8;137(19):e523-e557. doi: 10.1161/CIR.0000000000000564. Epub 2018 Feb 22.
Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.
自发性冠状动脉夹层 (SCAD) 已成为急性冠状动脉综合征、心肌梗死和猝死的重要原因，尤其是在年轻女性和传统动脉粥样硬化危险因素较少的人群中。患者发起的研究促使人们对 SCAD 的认识不断提高，诊断能力的提高和大型病例系列研究的结果导致了对初始和长期管理方法的改变，越来越多的证据表明，SCAD 不仅比以前认为的更为常见，而且必须与动脉粥样硬化性心肌梗死不同进行评估和治疗。SCAD 反复发作率高；其与女性、妊娠、身体和情绪压力触发因素的关联；以及同时存在的系统性血管疾病，特别是纤维肌性发育不良，突出了 SCAD 与动脉粥样硬化性疾病在临床特征上的差异。本文介绍了 SCAD 的病因、临床病程、治疗选择、结局和相关情况，以及许多持续存在的知识空白。
