Department of Internal Medicine, Icahn School of Medicine at Mount Sinai St' Luke and Mount Sinai West Hospitals, New York, New York.
Heart and Vascular Institute, Cleveland Clinic, Ohio.
Am J Cardiol. 2019 Jan 15;123(2):249-253. doi: 10.1016/j.amjcard.2018.10.012. Epub 2018 Oct 30.
The pathophysiology of spontaneous coronary artery dissection (SCAD) is heterogeneous, associated with systemic arteriopathies and inflammatory diseases, and often compounded by environmental precipitants, genetics, or stressors. However, the frequency of these associated conditions with SCAD on a population level remains unknown. Therefore, the objective of this analysis was to evaluate heterogeneous phenotypes of SCAD in the United States using data from the Nationwide Inpatient Sample collected from January 1, 2004, to September 31, 2015. Among 66,360 patients diagnosed with SCAD, the mean age was 63.1 ± 13.2 years and 44.2% were women. A total of 3,415 (5.14%) had depression, 670 (1.0%) had rheumatoid arthritis, 640 (0.96%) had anxiety, 545 (0.82%) had a migraine disorder, 440 (0.66%) used steroids, 385 (0.58%) had malignant hypertension, 280 (0.42%) had systemic lupus erythematosus, 250 (0.38%) had cocaine abuse, 215 (0.32%) had hypertensive heart or renal disease, 130 (0.19%) had coronary spasm, 105 (0.16%) had fibromuscular dysplasia, 85 (0.13%) had Crohn's disease, 75 (0.11%) had celiac disease, 60 (0.09%) had adult autosomal dominant polycystic kidney disease, 60 (0.09%) had hormone replacement therapy, 55 (0.08%) had sarcoidosis, 55 (0.08%) had amphetamine abuse, 15 (0.02%) had granulomatosis polyangiitis, 10 (0.02%) had α1-antitrypsin deficiency, 10 (0.02%) had Marfan syndrome, 10 (0.02%) had Ehlers-Danlos syndrome, 10 (0.02%) had Kawasaki disease, 10 (0.02%) had polyarteritis nodosa, and 5 (0.01%) had multiparity. In conclusion, most cases of SCAD had no apparent concomitant arteriopathy, inflammatory disorder, or evident risk factor.
自发性冠状动脉夹层 (SCAD) 的病理生理学是异质的，与系统性血管疾病和炎症性疾病有关，并且经常受到环境诱因、遗传或应激因素的影响。然而，在人群水平上，这些相关疾病在 SCAD 中的频率仍然未知。因此，本分析的目的是使用 2004 年 1 月 1 日至 2015 年 9 月 31 日期间从全国住院患者样本中收集的数据，在美国评估 SCAD 的异质表型。在 66360 例被诊断为 SCAD 的患者中，平均年龄为 63.1 ± 13.2 岁，44.2%为女性。共有 3415 例（5.14%）患有抑郁症，670 例（1.0%）患有类风湿关节炎，640 例（0.96%）患有焦虑症，545 例（0.82%）患有偏头痛障碍，440 例（0.66%）使用类固醇，385 例（0.58%）患有恶性高血压，280 例（0.42%）患有系统性红斑狼疮，250 例（0.38%）患有可卡因滥用，215 例（0.32%）患有高血压性心脏或肾脏疾病，130 例（0.19%）患有冠状动脉痉挛，105 例（0.16%）患有纤维肌性发育不良，85 例（0.13%）患有克罗恩病，75 例（0.11%）患有乳糜泻，60 例（0.09%）患有成人常染色体显性多囊肾病，60 例（0.09%）患有激素替代治疗，55 例（0.08%）患有结节病，55 例（0.08%）患有安非他命滥用，15 例（0.02%）患有肉芽肿性多血管炎，10 例（0.02%）患有α1-抗胰蛋白酶缺乏症，10 例（0.02%）患有马凡综合征，10 例（0.02%）患有埃勒斯-当洛斯综合征，10 例（0.02%）患有川崎病，10 例（0.02%）患有多发性大动脉炎，5 例（0.01%）有多产史。总之，大多数 SCAD 病例没有明显的伴发性血管疾病、炎症性疾病或明显的危险因素。
