Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain.
Servicio de Cardiología, Hospital Universitario Arnau de Vilanova & Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain.
Eur Heart J Acute Cardiovasc Care. 2023 May 4;12(5):299-305. doi: 10.1093/ehjacc/zuad035.
Spontaneous coronary artery dissection (SCAD) is a relatively infrequent cause of acute coronary syndrome. Clinical features, angiographic findings, management, and outcomes of SCAD patients who present reduced left ventricular ejection fraction (LVEF) remain unknown.
The Spanish multicentre prospective SCAD registry (NCT03607981), included 389 consecutive patients with SCAD. In 348 of these patients, LVEF could be assessed by echocardiography during the index admission. Characteristics and outcomes of patients with preserved LVEF (LVEF ≥50%, n = 295, 85%) were compared with those with reduced LVEF (LVEF <50%, n = 53, 15%). Mean age was 54 years and 90% of patients in both groups were women. The most frequent clinical presentation in patients with reduced LVEF was ST-segment elevation myocardial infarction (STEMI) (62% vs. 36%, P < 0.001), especially anterior STEMI. Proximal coronary segment and multi-segment involvement were also significantly more frequent in these patients. No differences were found on initial revascularization between groups. Patients with reduced LVEF significantly received more often neurohormonal antagonist therapy, and less frequently aspirin. In-hospital events were more frequent in these patients (13% vs. 5%, P = 0.01), with higher rates of death, cardiogenic shock, ventricular arrhythmia, and stroke. During a median follow-up of 28 months, the occurrence of a combined adverse event did not statistically differ between the two groups (19% vs. 12%, P = 0.13). However, patients with reduced LVEF had higher mortality (9% vs. 0.7%, P < 0.001) and readmission rates for heart failure (HF) (4% vs. 0.3%, P = 0.01).
Patients with SCAD and reduced LVEF show differences in clinical characteristics and angiographic findings compared with SCAD patients with preserved LVEF. Although these patients receive specific medications at discharge, they had higher mortality and readmission rates for HF during follow-up.
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征的一个相对少见的病因。目前尚不清楚左心室射血分数（LVEF）降低的 SCAD 患者的临床表现、血管造影结果、治疗方法和预后。
西班牙多中心前瞻性 SCAD 注册研究（NCT03607981）纳入了 389 例连续的 SCAD 患者。在这些患者中，有 348 例在入院时可通过超声心动图评估 LVEF。比较了保留 LVEF（LVEF≥50%，n=295，85%）和降低 LVEF（LVEF<50%，n=53，15%）患者的特征和结局。降低 LVEF 患者的平均年龄为 54 岁，两组中 90%的患者均为女性。降低 LVEF 患者中最常见的临床表现是 ST 段抬高型心肌梗死（STEMI）（62% vs. 36%，P<0.001），特别是前壁 STEMI。这些患者的近端冠状动脉节段和多节段受累也明显更常见。两组患者初始血运重建无差异。降低 LVEF 患者明显更常接受神经激素拮抗剂治疗，较少使用阿司匹林。这些患者住院期间事件更常见（13% vs. 5%，P=0.01），死亡率、心源性休克、室性心律失常和卒中等发生率更高。中位随访 28 个月期间，两组的复合不良事件发生率无统计学差异（19% vs. 12%，P=0.13）。然而，降低 LVEF 患者的死亡率（9% vs. 0.7%，P<0.001）和因心力衰竭（HF）再入院率（4% vs. 0.3%，P=0.01）更高。
与保留 LVEF 的 SCAD 患者相比，LVEF 降低的 SCAD 患者的临床表现和血管造影结果存在差异。尽管这些患者出院时接受了特定的药物治疗，但在随访期间死亡率和因 HF 再入院率更高。
