Würdinger Michael, Templin-Ghadri Jelena-Rima
Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich.
Ther Umsch. 2021 Feb;78(1):41-47. doi: 10.1024/0040-5930/a001235.
Spontaneous coronary artery dissection Spontaneous coronary artery dissection (SCAD) is an increasingly recognized etiology of acute coronary syndrome (ACS) and an important cause of myocardial infarction in women. First described in 1931, SCAD is defined as a spontaneous tear in a coronary artery that is not associated with atherosclerosis, trauma or medical intervention. SCAD predominantly affects younger women, who often lack atherosclerotic risk factors. Some risk factors that have been identified include female sex, pregnancy, severe emotional or physical stress, underlying blood vessel diseases such as fibromuscular dysplasia, and connective tissue diseases such as Ehlers-Danlos syndrome or Marfan syndrome. Previously believed to be rare, a chiefly fatal condition, recent epidemiological data suggests SCAD is accountable for up to 4 % of all ACS cases and up to 35 % of ACS cases in women < 50 years of age. There is a lack of awareness of SCAD among physicians, which probably results in underreporting and underdiagnosing of this disorder. The clinical presentation of SCAD is often similar to that of ACS making differentiation at first presentation difficult. Cardiac enzymes are elevated like in ACS and there are no biomarkers that are specific for the diagnosis of SCAD. Coronary angiography is the gold standard method to distinguish both entities, however correct diagnosis by cath is challenging and SCAD can be truly missed and misdiagnosed as classic ACS. Still there are no randomized controlled trials about the optimal treatment of these patients. But it is suggested that management should be different to atherosclerotic myocardial infarction. Conservative medical treatment is favored in the majority of cases, with percutaneous coronary intervention (PCI) being reserved for high risk patients due to poor interventional outcomes and higher failure rates. However, there is still a lack of data on this poorly understood condition and the optimal management has yet to be determined.
自发性冠状动脉夹层 自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征（ACS）中一种日益被认识到的病因，也是女性心肌梗死的重要原因。SCAD于1931年首次被描述，定义为冠状动脉的自发性撕裂，与动脉粥样硬化、创伤或医疗干预无关。SCAD主要影响年轻女性，她们通常缺乏动脉粥样硬化风险因素。已确定的一些风险因素包括女性性别、怀孕、严重的情绪或身体压力、潜在的血管疾病如纤维肌发育不良，以及结缔组织疾病如埃勒斯-当洛综合征或马凡综合征。以前认为SCAD很罕见，主要是一种致命疾病，但最近的流行病学数据表明，SCAD占所有ACS病例的比例高达4%，在50岁以下女性的ACS病例中占比高达35%。医生对SCAD缺乏认识，这可能导致该疾病报告不足和诊断不足。SCAD的临床表现通常与ACS相似，在初次就诊时难以鉴别。心肌酶像在ACS中一样升高，并且没有对SCAD诊断具有特异性的生物标志物。冠状动脉造影是区分这两种疾病的金标准方法，然而通过导管检查进行正确诊断具有挑战性，SCAD可能会被真正漏诊并被误诊为典型的ACS。目前仍然没有关于这些患者最佳治疗方法的随机对照试验。但建议治疗方法应与动脉粥样硬化性心肌梗死不同。在大多数情况下，倾向于保守药物治疗，由于介入效果差和失败率较高，经皮冠状动脉介入治疗（PCI）仅适用于高危患者。然而，对于这种了解甚少的疾病仍然缺乏数据，最佳治疗方案尚未确定。
