自发性冠状动脉夹层中血栓的存在：尸检结果的系统评价
The presence of thrombus in spontaneous coronary artery dissection: A systematic review of autopsy findings.
作者信息
Jaspan Vita N, Rapkiewicz Amy V, Reynolds Harmony R
机构信息
Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, United States of America.
Department of Pathology, NYU Long Island School of Medicine, United States of America.
出版信息
Am Heart J Plus. 2022 Apr 22;15:100135. doi: 10.1016/j.ahjo.2022.100135. eCollection 2022 Mar.
BACKGROUND
Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in young women. There is no consensus on optimal treatment, though a conservative approach including antiplatelet agents is commonly used. We hypothesized that most cases of SCAD would not demonstrate true lumen thrombus in the dissected artery, suggesting that anti-platelet agents might not have a role in the treatment of SCAD.
METHODS
We conducted a systematic review of the published literature through March 2022 to identify pathology images from individuals who died of SCAD. The images were independently reviewed by a pathologist to assess for the presence of thrombus and inflammatory cells.
RESULTS
We identified 40 cases from 34 publications with available pathology images and found only one case of true lumen thrombus. Additionally, we found that 53% of cases involved eosinophilic inflammation.
CONCLUSION
The role of antiplatelet agents in the treatment of SCAD should be re-evaluated. Further studies are needed to better understand the significance and treatment implications of eosinophilic inflammation.
背景
自发性冠状动脉夹层（SCAD）是年轻女性急性冠状动脉综合征的重要病因。尽管通常采用包括抗血小板药物在内的保守治疗方法，但对于最佳治疗方案尚无共识。我们推测，大多数SCAD病例在夹层动脉中不会出现真腔血栓，这表明抗血小板药物可能在SCAD的治疗中不起作用。
方法
我们对截至2022年3月发表的文献进行了系统综述，以识别死于SCAD的个体的病理图像。病理学家对这些图像进行独立评估，以确定是否存在血栓和炎症细胞。
结果
我们从34篇有可用病理图像的出版物中识别出40例病例，仅发现1例真腔血栓。此外，我们发现53%的病例涉及嗜酸性粒细胞炎症。
结论
应重新评估抗血小板药物在SCAD治疗中的作用。需要进一步研究以更好地了解嗜酸性粒细胞炎症的意义和治疗意义。
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