自发性冠状动脉夹层后的健康状况结局及其与其他急性心肌梗死的比较：VIRGO 经验。
Health status outcomes after spontaneous coronary artery dissection and comparison with other acute myocardial infarction: The VIRGO experience.
机构信息
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States of America.
出版信息
PLoS One. 2022 Mar 23;17(3):e0265624. doi: 10.1371/journal.pone.0265624. eCollection 2022.
BACKGROUND
Data on health status outcomes after spontaneous coronary artery dissection (SCAD) are limited.
METHODS AND FINDINGS
Using the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study we compared patients with SCAD and other acute myocardial infarction (AMI) at presentation (baseline), 1-month, and-12 months using standardized health status instruments. Among 3572 AMI patients ≤ 55 years, 67 had SCAD. SCAD patients were younger (median age (IQR) 45 (40.5-51) years vs. 48 (44-52) in other AMI, p = 0.003), more often female (92.5% vs. 66.6%), have college education (73.1% vs. 51.7%) and household income >$100,000 (43.3% vs. 17.7% (All p<0.001). SCAD patients at baseline had higher mean ± SD Short Form-12 [SF-12] physical component scores [PCS] (48.7±10.2 vs. 43.8±12.1, p<0.001) and mental component scores [MCS] (49.6±12.4 vs. 45.4±12.5, p = 0.008), and at 12-months [PCS (50.1±9.0 vs. 44.3±12.3, p<0.001) and MCS (53±10.1 vs 50.2±11.0, p = 0.045)]. The Euro-Quality of Life Scale [EQ-5D] VAS and EQ-5D index scores were similar at baseline, but higher at 12-months for SCAD (EQ-5D VAS: 82.2±10.2 vs. 72.3±21.0, p<0.001; EQ-5D index scores; 90.2±15.3 vs. 83.7±19.8, p = 0.012). SCAD patients had better baseline Seattle Angina Questionnaire [SAQ] physical limitation (88.8±20.1 vs. 81.2±25.4, p = 0.017). At 12-months SCAD patients had better physical limitation (98.0±8.5 vs. 91.4±18.8, p = 0.007), angina frequency (96.4±8.8 vs. 91.3±16.8, p = 0.018) and quality of life scores (80.7±14.7 vs 72.2±23.2, p = 0.005). Magnitude of change in health status from baseline to 12-months was not statistically different between the groups. After adjustment for time and comorbidities there remained no difference in most health status outcomes.
CONCLUSIONS
SCAD patients fare marginally better than other AMI patients on most health status instruments and have similar 12-month health status recovery. Better pre-event health status suggests a need to modify exercise prescriptions and cardiac rehabilitation protocols to better assist this physically active population to recover.
背景
自发性冠状动脉夹层（SCAD）后健康状况结果的数据有限。
方法和发现
使用 Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) 研究，我们使用标准化的健康状况工具比较了在就诊时（基线）、1 个月和 12 个月的 SCAD 和其他急性心肌梗死（AMI）患者。在 3572 名≤55 岁的 AMI 患者中，有 67 例 SCAD。SCAD 患者更年轻（中位数年龄（IQR）45（40.5-51）岁 vs. 其他 AMI 患者 48（44-52）岁，p=0.003），更多为女性（92.5% vs. 66.6%），具有大学学历（73.1% vs. 51.7%）和家庭收入>100,000 美元（43.3% vs. 17.7%）（所有 p<0.001）。SCAD 患者在基线时的短式健康状况调查 12 项（SF-12）[PCS]（48.7±10.2 vs. 43.8±12.1，p<0.001）和 MCS（49.6±12.4 vs. 45.4±12.5，p=0.008）得分更高，在 12 个月时 [PCS（50.1±9.0 vs. 44.3±12.3，p<0.001）和 MCS（53±10.1 vs 50.2±11.0，p=0.045）]。欧洲生命质量量表（EQ-5D）VAS 和 EQ-5D 指数得分在基线时相似，但 SCAD 患者在 12 个月时更高（EQ-5D VAS：82.2±10.2 vs. 72.3±21.0，p<0.001；EQ-5D 指数评分；90.2±15.3 vs. 83.7±19.8，p=0.012）。SCAD 患者的西雅图心绞痛问卷（SAQ）[PCS]身体限制得分更好（88.8±20.1 vs. 81.2±25.4，p=0.017）。在 12 个月时，SCAD 患者的身体限制（98.0±8.5 vs. 91.4±18.8，p=0.007）、心绞痛频率（96.4±8.8 vs. 91.3±16.8，p=0.018）和生活质量评分（80.7±14.7 vs 72.2±23.2，p=0.005）更好。从基线到 12 个月健康状况的变化程度在两组之间没有统计学差异。在调整时间和合并症后，大多数健康状况结果仍没有差异。
结论
与其他 AMI 患者相比，SCAD 患者在大多数健康状况工具上的表现略好，并且在 12 个月时的健康状况恢复相似。更好的预先事件健康状况表明需要修改运动处方和心脏康复方案，以更好地帮助这一活跃的人群恢复。
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