Cardiology Department, ZNA Hartcentrum - ZNA Middelheim, Antwerp, Belgium.
Acta Cardiol. 2021 Sep;76(7):727-731. doi: 10.1080/00015385.2020.1778373. Epub 2020 Jun 19.
Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS), rapidly gaining recognition over the last decade. SCAD occurs predominantly in young, otherwise healthy women and coronary angiogram often lacks typical (atherosclerotic) features. Therefore, SCAD remains notably underdiagnosed. As optimal treatment strategy differs greatly from atherosclerotic ACS, early (differential) diagnosis is crucial.
PURPOSE/METHODS: In this paper, all coronary angiograms performed for ACS in women up to 50 years of age were retrospectively reviewed by three independent interventional cardiologists.
The obtained insights are comparable to recent literature. SCAD incidence was 26% in this cohort. Left anterior descending coronary artery was the main affected vessel with SCAD subtype 2B as predominant angiographic presentation. Correct diagnosis during index procedure was poor with only 33% accuracy. Nevertheless, a favourable trend over time was noted. Percutaneous coronary intervention success was 56%, as in 44% of patients initial stenting was complicated by progressive dissection. Overall, outcome was excellent with no reported fatalities.
SCAD remains an underdiagnosed subtype of ACS and the importance of increasing awareness amongst (interventional) cardiologists needs to be emphasised.
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征（ACS）的一个不常见病因，在过去十年中得到了越来越多的认识。SCAD 主要发生在年轻、健康的女性中，冠状动脉造影通常缺乏典型（动脉粥样硬化）特征。因此，SCAD 的诊断明显不足。由于最佳治疗策略与动脉粥样硬化性 ACS 有很大不同，早期（鉴别）诊断至关重要。
目的/方法：本文回顾性分析了 3 名介入心脏病专家对所有年龄在 50 岁以下的女性 ACS 进行的冠状动脉造影。
该队列中 SCAD 的发生率为 26%。左前降支是主要受累血管，SCAD 亚型 2B 是主要的血管造影表现。在指数程序中的正确诊断率很差，只有 33%的准确率。尽管如此，随着时间的推移，这一趋势有所改善。经皮冠状动脉介入治疗的成功率为 56%，44%的患者在初始支架置入时出现进展性夹层。总的来说，结果非常好，没有报告死亡病例。
SCAD 仍然是 ACS 的一种诊断不足的亚型，需要强调提高（介入）心脏病专家的认识。
