Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, Madrid, Spain.
Department of Preventive Medicine, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, Spain; Fundación Instituto Para la Mejora de la Asistencia Sanitaria, Madrid, Spain.
JACC Cardiovasc Interv. 2023 Aug 14;16(15):1860-1869. doi: 10.1016/j.jcin.2023.05.044.
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction. Revascularization in SCAD remains very challenging and therefore is not recommended as the initial management strategy in stable SCAD without high-risk features.
The aim of this study was to compare in-hospital mortality and 30-day readmission rates between patients with SCAD with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) and patients with STEMI without SCAD undergoing PPCI.
This study was conducted using the administrative minimum dataset of the Spanish National Health System (2016-2020). Risk-standardized in-hospital mortality ratios and readmission ratios were calculated, and results were adjusted using propensity score (PS) analyses.
A total of 65,957 episodes of PPCI were identified after exclusions. The crude in-hospital mortality rate was 4.8%. Of these, 315 (0.5%) were SCAD PPCI and 65,642 were non-SCAD PPCI. SCAD PPCI patients were younger and more frequently women than non-SCAD PPCI patients. Crude mortality (5.7% vs 4.8%), risk-standardized in-hospital mortality ratio (5.3% vs 5.3%), and PS-adjusted (315 pairs) mortality (5.7% vs 5.7%) were similar in SCAD PPCI and non-SCAD PPCI patients. In addition, crude (3% vs 3.3%) and PS-adjusted (297 pairs) 30-day readmission rates (3% vs 4%) were also similar in both groups.
PPCI, when indicated in patients with STEMI and SCAD, has similar in-hospital mortality and 30-day readmission rates compared with PPCI for atherothrombotic STEMI. These findings support the value of PPCI in selected patients with SCAD.
自发性冠状动脉夹层（SCAD）是急性心肌梗死的一个罕见病因。在没有高危特征的稳定型 SCAD 中，血运重建仍然极具挑战性，因此不建议作为初始治疗策略。
本研究旨在比较接受直接经皮冠状动脉介入治疗（PPCI）的 SCAD 伴 ST 段抬高型心肌梗死（STEMI）患者与接受 PPCI 的非 SCAD STEMI 患者的住院期间死亡率和 30 天再入院率。
本研究使用了西班牙国家卫生系统的行政最小数据集（2016-2020 年）。计算了风险标准化的住院期间死亡率比和再入院率，并使用倾向评分（PS）分析进行了校正。
排除后共确定了 65957 例 PPCI 病例。住院期间的粗死亡率为 4.8%。其中，315 例（0.5%）为 SCAD PPCI，65642 例为非 SCAD PPCI。SCAD PPCI 患者比非 SCAD PPCI 患者更年轻，且更常为女性。SCAD PPCI 和非 SCAD PPCI 患者的粗死亡率（5.7% vs 4.8%）、风险标准化的住院期间死亡率比（5.3% vs 5.3%）和 PS 校正（315 对）死亡率（5.7% vs 5.7%）相似。此外，两组的粗（3% vs 3.3%）和 PS 校正（297 对）30 天再入院率（3% vs 4%）也相似。
在 STEMI 合并 SCAD 的患者中，当指征明确时，PPCI 的住院期间死亡率和 30 天再入院率与 PPCI 治疗动脉粥样硬化性 STEMI 相似。这些发现支持在有选择的 SCAD 患者中使用 PPCI。
