Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
JACC Cardiovasc Interv. 2019 Mar 25;12(6):518-527. doi: 10.1016/j.jcin.2018.12.011. Epub 2019 Feb 27.
Given the uncertainty regarding the degree and prevalence of spontaneous healing following spontaneous coronary artery dissection (SCAD), the aim of this study was to assess the angiographic characteristics of the dissected segments in a large cohort of patients with SCAD who underwent subsequent repeat coronary angiography.
SCAD is an uncommon yet important cause of myocardial infarction in women. Very little is known about the characteristics of healing of dissected arteries.
Patients with nonatherosclerotic SCAD followed prospectively at Vancouver General Hospital who underwent repeat angiography were included in this study. Those who underwent percutaneous coronary intervention for SCAD were excluded. Baseline patient demographics and in-hospital and long-term cardiovascular events were recorded. Angiographic characteristics of the SCAD artery at index and repeat angiography were assessed by 2 experienced angiographers. Criteria for angiographic healing were as follows: 1) improvement of stenosis severity from index event; 2) residual stenosis <50%; and 3) TIMI (Thrombolysis In Myocardial Infarction) flow grade 3.
One hundred fifty-six patients with 182 noncontiguous SCAD lesions were included. The mean age was 51.5 ± 8.7 years, 88.5% were women, 83.3% were Caucasian, and 75.6% had fibromuscular dysplasia. All patients presented with myocardial infarction. At index angiography, type 2 SCAD was most commonly observed, in 126 of 182 lesions (69.2%); TIMI flow grade <3 was present in 85 of 182 (46.7%); and median lesion stenosis was 79.0% (interquartile range: 56.0% to 100%). Median time to repeat angiography was 154 days (interquartile range: 70 to 604 days), with median residual lesion stenosis improving to 25.5% (interquartile range: 12.0 to 38.8 days), and TIMI flow grade <3 observed in 10 of 182 lesions (5.5%). Angiographic healing occurred in 157 of 182 lesions (86.3%). Of repeat angiography performed ≥30 days post-SCAD, 152 of 160 (95%) showed spontaneous angiographic healing.
The majority of coronary arteries affected by SCAD heal spontaneously on repeat angiography, with apparent time dependency, with the vast majority having complete healing after 30 days from the SCAD event.
鉴于自发性冠状动脉夹层（SCAD）后自发愈合的程度和普遍性存在不确定性，本研究旨在评估在接受后续重复冠状动脉造影的大量 SCAD 患者中，夹层节段的血管造影特征。
SCAD 是女性心肌梗死的一个不太常见但很重要的原因。关于愈合动脉的特征知之甚少。
前瞻性纳入在温哥华综合医院接受治疗的非动脉粥样硬化性 SCAD 患者，并进行重复血管造影，排除因 SCAD 而行经皮冠状动脉介入治疗的患者。记录基线患者人口统计学资料、住院期间和长期心血管事件。由 2 名有经验的血管造影医师评估索引和重复血管造影时 SCAD 动脉的血管造影特征。血管造影愈合的标准如下：1）从指数事件起狭窄严重程度改善；2）残余狭窄<50%；3）TIMI（血栓溶解治疗心肌梗死）血流分级 3 级。
共纳入 156 例 182 处非连续 SCAD 病变患者，平均年龄为 51.5±8.7 岁，88.5%为女性，83.3%为白种人，75.6%为纤维肌性发育不良。所有患者均表现为心肌梗死。在索引血管造影中，126 处病变（69.2%）为 2 型 SCAD；182 处病变中有 85 处（46.7%）存在 TIMI 血流分级<3；中位病变狭窄为 79.0%（四分位间距：56.0%至 100%）。中位重复血管造影时间为 154 天（四分位间距：70 天至 604 天），中位残余病变狭窄程度改善至 25.5%（四分位间距：12.0%至 38.8 天），182 处病变中有 10 处（5.5%）出现 TIMI 血流分级<3。182 处病变中有 157 处（86.3%）出现血管造影愈合。在 SCAD 后≥30 天进行的重复血管造影中，160 处中的 152 处（95%）显示自发血管造影愈合。
在重复血管造影中，大多数受 SCAD 影响的冠状动脉会自发愈合，且具有明显的时间依赖性，绝大多数在 SCAD 事件后 30 天内完全愈合。
