Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand.
Biostatistics, Canterbury District Health Board, Christchurch, New Zealand.
Heart Lung Circ. 2021 Jan;30(1):78-85. doi: 10.1016/j.hlc.2020.06.020. Epub 2020 Sep 4.
Spontaneous coronary artery dissection (SCAD) is an important but under-recognised cause of acute coronary syndrome (ACS), particularly in younger women. We assessed trends in the detection, management and outcomes of all patients with SCAD over 6 consecutive years.
All patients with first diagnosis of SCAD at Christchurch Public Hospital, New Zealand, between January 2014 and January 2020 were included. Patient management and outcomes were determined by retrospective review of medical records. SCAD presentations were compared to total ACS presentations, obtained from a national ACS (ANZACS-QI) database.
We identified 113 patients with angiographic diagnosis of SCAD. Median age was 54 years (88% female). The detection of SCAD increased over the period, both as a total number (Kendall's τ 0.87, p=0.015) and as a proportion of all ACS (p value for trend <0.0001). In 2019, SCAD represented 2.4% of all ACS and 18% of ACS in females aged less than 60 years. The most common presentation was non-ST elevation myocardial infarction (NSTEMI) in 72%; and, there was an increase in NSTEMI compared with STEMI over the period (p=0.023). Initial strategy of percutaneous coronary intervention (PCI) was undertaken in 12% of patients, with a significant trend towards a more conservative approach over the study period (p=0.019). The rate of 30-day major adverse cardiovascular events (MACE) was 8.8% overall, and significantly reduced over the study period to 3% in 2019 (p value for trend, 0.006).
The detection of SCAD has increased and is a particularly important cause of ACS in younger women. This increase has been largely driven by an increasing number of NSTEMI patients diagnosed with SCAD, associated with a significant improvement in 30-day MACE.
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征（ACS）的一个重要但认识不足的原因，特别是在年轻女性中。我们评估了连续 6 年来所有 SCAD 患者的检测、治疗和结局趋势。
所有在新西兰克赖斯特彻奇公立医院首次诊断为 SCAD 的患者均纳入本研究。通过回顾病历确定患者的管理和结局。将 SCAD 的表现与从全国 ACS（ANZACS-QI）数据库中获得的所有 ACS 表现进行比较。
我们共确定了 113 例经血管造影诊断的 SCAD 患者。中位年龄为 54 岁（88%为女性）。在此期间，SCAD 的检出率呈上升趋势，无论是总数（Kendall's τ 0.87，p=0.015）还是所有 ACS 中的比例（趋势 p 值<0.0001）。2019 年，SCAD 占所有 ACS 的 2.4%，占年龄小于 60 岁的女性 ACS 的 18%。最常见的表现是无 ST 段抬高型心肌梗死（NSTEMI）占 72%；并且在此期间，NSTEMI 的比例较 STEMI 有所增加（p=0.023）。最初的经皮冠状动脉介入治疗（PCI）策略在 12%的患者中进行，研究期间呈现出更为保守的趋势（p=0.019）。30 天主要不良心血管事件（MACE）的发生率总体为 8.8%，在研究期间显著降低至 2019 年的 3%（趋势 p 值，0.006）。
SCAD 的检出率有所增加，并且是年轻女性 ACS 的一个特别重要的原因。这种增加主要是由于越来越多的 NSTEMI 患者被诊断为 SCAD，与 30 天 MACE 的显著改善有关。
