Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, 92323Fudan University, shanghai, China.
Angiology. 2022 Apr;73(4):374-379. doi: 10.1177/00033197211036220. Epub 2021 Aug 4.
Spontaneous coronary intramural hematoma (SCIH) was one type of spontaneous coronary artery dissection without obvious intimal tear, which is easy to misdiagnose. We aimed to study the characteristics, management, and prognosis of SCIH in our center. All the SCIH patients (n = 30) diagnosed by coronary angiography from January 1, 2012 to December 31, 2018 were enrolled. The demographic characteristics, history, therapy, and follow-up were collected. The mean age of the patients was 51.8 ± 9.5 years. Most of the patients were females (66.7%) with hypertension. Patients with diffuse lesion, focal lesion, and multiple vessels were 70%, 13.3%, and 16.7%, respectively. Conservative treatment was the first choice (76.7%). The mean follow-up time was 29.3 ± 13.5 months. None of the patients had unplanned readmission due to worsening symptoms. Nine patients underwent coronary artery computed tomography reexamination after 10.3 ± 7.5 months, which showed complete recovery of SCIH. Eight patients were hospitalized for coronary angiography 6.4 ± 4.7 months later, which did not show any sign of SCIH. Spontaneous coronary intramural hematoma was most common in post-menopausal women with hypertension. Possibly, antiplatelet drugs should be avoided in SCIH. Waiting for the hematoma to heal was preferable and had a good prognosis.
自发性冠状动脉壁内血肿（SC IH）是一种无明显内膜撕裂的自发性冠状动脉夹层，容易误诊。我们旨在研究本中心 SC IH 的特征、处理和预后。2012 年 1 月 1 日至 2018 年 12 月 31 日，通过冠状动脉造影诊断为 SC IH 的所有患者（n=30）均被纳入研究。收集了患者的人口统计学特征、病史、治疗和随访情况。患者的平均年龄为 51.8±9.5 岁。大多数患者为女性（66.7%），伴有高血压。弥漫性病变、局灶性病变和多支病变患者分别占 70%、13.3%和 16.7%。保守治疗是首选（76.7%）。平均随访时间为 29.3±13.5 个月。无患者因症状恶化而计划再次入院。9 例患者在 10.3±7.5 个月后接受冠状动脉计算机断层扫描复查，显示 SC IH 完全恢复。8 例患者在 6.4±4.7 个月后因冠状动脉造影住院，未发现任何 SC IH 迹象。自发性冠状动脉壁内血肿最常见于绝经后伴高血压的女性。可能需要避免在 SC IH 中使用抗血小板药物。等待血肿愈合是首选方法，预后良好。
