自发性冠状动脉夹层导致心搏骤停患者的特征和结局。
Characteristics and outcomes of patients with spontaneous coronary artery dissection who suffered sudden cardiac arrest.
机构信息
Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, 1526 North Edgemont Street, 2nd Floor, Los Angeles, CA, 90027, USA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
出版信息
J Interv Card Electrophysiol. 2021 Jan;60(1):77-83. doi: 10.1007/s10840-019-00695-9. Epub 2020 Feb 11.
PURPOSE
Spontaneous coronary artery dissection (SCAD) can cause life-threatening ventricular arrhythmias, but the characteristics and outcomes of this population are not well characterized. We sought to determine the characteristics and outcomes of patients with SCAD who suffered sudden cardiac arrest, whether treated with or without an implantable cardioverter-defibrillator (ICD).
METHODS
Retrospective cohort study of patients diagnosed with SCAD between 2006 and 2016.
RESULTS
Eleven of 208 SCAD patients suffered sudden cardiac arrest (5.3%). Those who suffered cardiac arrest were more likely to have pregnancy-associated SCAD (27.3% vs 7.1%, p = 0.018). They were more likely to have left main (18.2% vs 1.0%, p = 0.01) or proximal coronary vessel involvement (36.4% vs 8.1%, p = 0.002), and with left ventricular ejection fraction of < 50% (45.5% vs 13.2%, p = 0.013). Percutaneous coronary intervention was more commonly performed in patients who suffered cardiac arrest (54.6% vs 8.6%, p < 0.001). Left main or proximal LAD involvement increased the odds of cardiac arrest by over 6-fold (OR 6.2, 95% CI 1.2-32.9, p = 0.03). Eight of the 11 patients suffered VT/VF arrest, of which one was treated with an ICD and one with a wearable cardioverter-defibrillator. Of these, no shocks were reported at follow-up and no ventricular arrhythmic events were reported in those not receiving defibrillator treatment.
CONCLUSION
Sudden cardiac arrest in SCAD patients is associated with left main or proximal coronary lesions. Secondary prevention ICD did not show benefit in this cohort. Future larger studies are needed to determine the role of ICD therapy in SCAD patients who suffer cardiac arrest.
目的
自发性冠状动脉夹层（SCAD）可导致危及生命的室性心律失常，但此类患者的特征和结局尚未得到很好的描述。本研究旨在确定发生心搏骤停的 SCAD 患者的特征和结局，无论是否植入植入式心脏复律除颤器（ICD）。
方法
回顾性分析 2006 年至 2016 年间诊断为 SCAD 的患者队列。
结果
在 208 例 SCAD 患者中，有 11 例（5.3%）发生心搏骤停。发生心搏骤停的患者更有可能患有与妊娠相关的 SCAD（27.3% vs 7.1%，p=0.018）。他们更有可能发生左主干（18.2% vs 1.0%，p=0.01）或近端冠状动脉受累（36.4% vs 8.1%，p=0.002），且左心室射血分数<50%（45.5% vs 13.2%，p=0.013）。心搏骤停患者更常接受经皮冠状动脉介入治疗（54.6% vs 8.6%，p<0.001）。左主干或近端左前降支受累使心搏骤停的几率增加了 6 倍以上（OR 6.2，95%CI 1.2-32.9，p=0.03）。11 例心搏骤停患者中有 8 例发生 VT/VF 骤停，其中 1 例接受 ICD 治疗，1 例接受可穿戴式除颤器治疗。在这些患者中，随访时没有报告电击事件，未接受除颤器治疗的患者也没有发生室性心律失常事件。
结论
SCAD 患者发生心搏骤停与左主干或近端冠状动脉病变有关。在本队列中，二级预防 ICD 未显示获益。需要进一步进行更大规模的研究，以确定 ICD 治疗在心搏骤停的 SCAD 患者中的作用。
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