Abreu Glória, Galvão Braga Carlos, Costa João, Azevedo Pedro, Marques Jorge
Cardiology Department, Hospital de Braga, Braga, Portugal.
Cardiology Department, Hospital de Braga, Braga, Portugal.
Rev Port Cardiol (Engl Ed). 2018 Aug;37(8):707-713. doi: 10.1016/j.repc.2017.07.019. Epub 2018 Jun 21.
Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS). Better recognition and diagnosis has raised awareness of this condition. However, the pathophysiology of SCAD and its prognosis are still little understood. We aimed to investigate the characteristics and prognosis of patients with SCAD, and subsequently performed a review of literature.
Single-center, retrospective study performed in patients hospitalized from January 2010 to December 2016 with suspected ACS (n=5002) whose final diagnosis was SCAD (n=27; 0.5%).
Patients with SCAD were mainly female (81.5%; n=22), with median age of 56. Predisposing factors were identified in 12 (44%) patients and precipitating factors in three (11.1%). Non-ST elevation myocardial infarction (NSTEMI) was the main form of presentation (51.9%). The left anterior descending artery (LAD) territory was the most commonly involved (n=12, 44.4%). Type 2 dissection was the most prevalent angiographic pattern (n=17, 63%). The majority of patients (n=15; 55.6%) were managed medically and the remaining patients underwent percutaneous coronary intervention (PCI) with drug-eluting stents. Seven patients re-infarcted while in the hospital. Over the median follow-up period of 20 months, 7.4% of patients (n=2) had symptoms of heart failure (HF) and 14.8% developed ACS (in three patients the event occurred in a coronary territory other than that of the index case, and in one patient it occurred in the previously affected territory). There were no deaths.
In the studied population, SCAD was more prevalent in middle-aged women. Despite the high prevalence of in-hospital re-infarction or during follow-up, the prognosis was good overall.
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征（ACS）的一种不常见病因。对其更好的认识和诊断提高了对这种疾病的认知。然而，SCAD的病理生理学及其预后仍知之甚少。我们旨在研究SCAD患者的特征和预后，随后进行了文献综述。
对2010年1月至2016年12月因疑似ACS住院的患者（n = 5002）进行单中心回顾性研究，最终诊断为SCAD的患者有27例（0.5%）。
SCAD患者以女性为主（81.5%；n = 22），中位年龄为56岁。12例（44%）患者存在易感因素，3例（11.1%）有诱发因素。非ST段抬高型心肌梗死（NSTEMI）是主要的表现形式（51.9%）。左前降支动脉（LAD）区域是最常受累的部位（n = 12，44.4%）。2型夹层是最常见的血管造影模式（n = 17，63%）。大多数患者（n = 15；55.6%）接受药物治疗，其余患者接受药物洗脱支架的经皮冠状动脉介入治疗（PCI）。7例患者在住院期间再次发生心肌梗死。在中位随访期20个月内，7.4%的患者（n = 2）出现心力衰竭（HF）症状，14.8%的患者发生ACS（3例事件发生在非索引病例的冠状动脉区域，1例发生在先前受累区域）。无死亡病例。
在研究人群中，SCAD在中年女性中更为普遍。尽管住院期间或随访期间再次发生心肌梗死的发生率较高，但总体预后良好。
