自发性冠状动脉夹层患者动脉高血压的临床意义。
Clinical implications of arterial hypertension in patients with spontaneous coronary artery dissection.
机构信息
Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid.
Cardiac Department, Hospital del Mar - Parc de Salut Mar.
出版信息
Coron Artery Dis. 2022 Mar 1;33(2):75-80. doi: 10.1097/MCA.0000000000001043.
BACKGROUND
Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome. Many patients with SCAD have associated coronary risk factors. However, the implications of arterial hypertension in SCAD patients remain unknown.
OBJECTIVE
This study sought to assess the clinical implications of arterial hypertension in a nationwide cohort of patients with SCAD.
METHODS
The Spanish SCAD registry (NCT03607981) prospectively enrolled 318 consecutive patients. All coronary angiograms were centrally analyzed to confirm the diagnosis of SCAD. Patients were classified according to the presence of arterial hypertension.
RESULTS
One-hundred eighteen patients (37%) had a diagnosis of arterial hypertension. Hypertensive SCAD patients were older (60 ± 12 vs. 51 ± 9 years old) and had more frequently dyslipidemia (56 vs. 23%) and diabetes (9 vs. 3%) but were less frequently smokers (15 vs. 35%) than normotensive SCAD patients (all P < 0.05). Most patients in both groups were female (90 vs. 87%, NS) and female patients with hypertension were more frequently postmenopausal (70 vs. 47%, P < 0.05). Hypertensive SCAD patients had more severe lesions and more frequently multivessel involvement (15 vs. 7%, P < 0.05) and coronary ectasia (19 vs. 7%, P < 0.05) but showed a similar prevalence of coronary tortuosity (34 vs. 26%, NS). Revascularization requirement was similar in both groups (17 vs. 26%, NS) but procedural success was significantly lower (65 vs. 88%, P < 0.05) and procedural-related complications more frequent (65 vs. 41%, P < 0.05) in SCAD patients with hypertension.
CONCLUSION
Patients with SCAD and hypertension are older, more frequently postmenopausal and have more coronary risk factors than normotensive SCAD patients. During revascularization SCAD patients with hypertension obtain poorer results and have a higher risk of procedural-related complications (NCT03607981).
背景
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征的一个罕见但日益被认识的病因。许多 SCAD 患者存在相关的冠状动脉危险因素。然而，动脉高血压在 SCAD 患者中的影响仍不清楚。
目的
本研究旨在评估动脉高血压在全国性 SCAD 患者队列中的临床意义。
方法
西班牙 SCAD 登记研究（NCT03607981）前瞻性纳入了 318 例连续患者。所有冠状动脉造影均经中心分析证实 SCAD 的诊断。患者根据是否存在动脉高血压进行分类。
结果
118 例（37%）患者诊断为动脉高血压。高血压性 SCAD 患者年龄更大（60±12 岁 vs. 51±9 岁），更常伴有血脂异常（56% vs. 23%）和糖尿病（9% vs. 3%），但吸烟率更低（15% vs. 35%）（均 P<0.05）。两组患者均以女性为主（90% vs. 87%，NS），高血压女性患者更常处于绝经后状态（70% vs. 47%，P<0.05）。高血压性 SCAD 患者病变更严重，更常多支血管受累（15% vs. 7%，P<0.05）和冠状动脉扩张（19% vs. 7%，P<0.05），但冠状动脉迂曲的发生率相似（34% vs. 26%，NS）。两组患者的血运重建需求相似（17% vs. 26%，NS），但高血压性 SCAD 患者的手术成功率明显较低（65% vs. 88%，P<0.05），手术相关并发症更常见（65% vs. 41%，P<0.05）。
结论
与非高血压性 SCAD 患者相比，高血压性 SCAD 患者年龄更大，更常处于绝经后状态，且具有更多的冠状动脉危险因素。在血运重建过程中，高血压性 SCAD 患者的结果较差，手术相关并发症的风险更高（NCT03607981）。
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