Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA; email:
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA; email:
Annu Rev Med. 2022 Jan 27;73:339-354. doi: 10.1146/annurev-med-052819-023826.
Spontaneous coronary artery dissection (SCAD) is an uncommon but increasingly recognized cause of acute myocardial infarction (MI) among young and middle-aged women and is an important cause of pregnancy-associated MI. Over 90% of SCAD patients are women. Compared to patients with MI caused by atherosclerosis, SCAD patients have fewer cardiovascular risk factors but more often have systemic arteriopathy, most commonly fibromuscular dysplasia. Angiographically, SCAD is characterized by the presence of an intramural hematoma with or without an intimal tear. Accurate recognition of characteristic findings on coronary angiography is critical, as there are important differences in the acute and long-term management of MI caused by SCAD versus atherosclerosis. Acutely, most SCAD patients should be managed conservatively, since percutaneous revascularization is associated with more complications and SCAD-affected vessels usually heal without intervention. Randomized clinical trials and other prospective evaluations are needed, especially to clarify optimal treatment and prevention strategies.
自发性冠状动脉夹层（SCAD）是中青年女性急性心肌梗死（MI）的一个不常见但日益被认识的病因，也是妊娠相关 MI 的一个重要病因。超过 90%的 SCAD 患者为女性。与动脉粥样硬化性 MI 患者相比，SCAD 患者的心血管危险因素较少，但更常伴有系统性动脉病变，最常见的是纤维肌性发育不良。血管造影表现为伴或不伴内膜撕裂的壁内血肿。准确识别冠状动脉造影的特征性表现至关重要，因为 SCAD 与动脉粥样硬化性 MI 在急性期和长期管理方面存在重要差异。急性发作时，大多数 SCAD 患者应接受保守治疗，因为经皮血运重建与更多并发症相关，且 SCAD 受累血管通常无需干预即可愈合。需要开展随机临床试验和其他前瞻性评估，特别是为了明确最佳治疗和预防策略。
