Ciliberti Giuseppe, Westaby Joseph, Papadakis Michael, Behr Elijah R, Sharma Sanjay, Finocchiaro Gherardo, Sheppard Mary N
Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti," Ancona, Italy (G.C.).
Cardiovascular Pathology Department (J.W., M.N.S.), St. George's, University of London, United Kingdom.
Arterioscler Thromb Vasc Biol. 2023 May;43(5):787-792. doi: 10.1161/ATVBAHA.122.318401. Epub 2023 Feb 9.
Spontaneous coronary artery dissection (SCAD) and myocardial infarction with nonobstructed coronary arteries (MINOCA) are increasingly recognized causes of acute coronary syndrome and potentially of sudden cardiac death (SCD). SCAD has been correlated to coronary fibromuscular dysplasia (FMD), but the prevalence of SCAD and FMD among SCD victims is unclear. Therefore, we sought to assess characteristics of decedents with SCAD found at autopsy and to compare their clinical and pathological profile with MINOCA victims.
We reviewed a database of 5325 consecutive cases of SCDs referred to our cardiac pathology center between 1994 and 2017.
We identified 18 (0.3%) cases with SCAD and 37 (0.7%) with MINOCA. No signs of coronary FMD were found among SCAD and MINOCA victims. Compared to MINOCA, SCAD decedents were mostly females (78% versus 38%, =0.006) and SCD occurred during peripartum more frequently in SCAD rather than MINOCA female victims (28% versus 3%, =0.012) Infarcted myocardium was identified in all cases of MINOCA but only in 5 (28%) of SCAD decedents (<0.001). Premortem cardiac symptoms were present in 100% of SCAD and 49% of MINOCA victims (<0.001); substances use or abuse was reported in none of SCAD versus 43% of MINOCA decedents (=0.001).
SCAD and MINOCA are rare causes of SCD. At autopsy, coronary FMD is not present among SCAD victims. Compared to MINOCA, SCAD victims are more frequently females, are linked to pregnancy, and always experienced premortem cardiac symptoms. Among MINOCA victims' substance use or abuse is common.
自发性冠状动脉夹层（SCAD）和冠状动脉无阻塞性心肌梗死（MINOCA）越来越被认为是急性冠状动脉综合征以及潜在的心源性猝死（SCD）的病因。SCAD与冠状动脉纤维肌发育不良（FMD）有关，但SCD受害者中SCAD和FMD的患病率尚不清楚。因此，我们试图评估尸检时发现的SCAD死者的特征，并将其临床和病理特征与MINOCA受害者进行比较。
我们回顾了1994年至2017年间转诊至我们心脏病理中心的5325例连续SCD病例的数据库。
我们确定了18例（0.3%）SCAD病例和37例（0.7%）MINOCA病例。在SCAD和MINOCA受害者中未发现冠状动脉FMD的迹象。与MINOCA相比，SCAD死者大多为女性（78%对38%，P = 0.006），SCAD女性受害者在围产期发生SCD的频率高于MINOCA女性受害者（28%对3%，P = 0.012）。所有MINOCA病例均发现梗死心肌，而SCAD死者中只有5例（28%）发现梗死心肌（P < 0.001）。100%的SCAD受害者和49%的MINOCA受害者生前有心脏症状（P < 0.001）；SCAD死者均未报告有物质使用或滥用情况，而MINOCA死者中有43%报告有物质使用或滥用情况（P = 0.001）。
SCAD和MINOCA是SCD的罕见病因。尸检时，SCAD受害者中不存在冠状动脉FMD。与MINOCA相比，SCAD受害者更常为女性，与妊娠有关，且生前总是出现心脏症状。MINOCA受害者中物质使用或滥用情况很常见。
