自发性冠状动脉夹层临床特点分析

Clinical Characteristics of Spontaneous Coronary Artery Dissection

目的:通过回顾性分析自发性冠状动脉夹层(spontaneous coronary artery dissection, SCAD)患者的临床特点,进一步探讨其诊治策略。方法:回顾阜外医院2004年1月至2017年11月期间,病历系统中诊断为冠状动脉夹层的病例58例,共发现SCAD患者24例,对其临床资料、影像学特征及随访结果进行分析。结果:24例SCAD患者平均年龄(48.1±13.3)岁,女性8例(33.3%),18例(75.0%)以急性冠状动脉综合征起病。冠状动脉造影共发现28处夹层病变,病变类型均为1型,15处(53.6%)病变累及右冠状动脉,有4例(16.7%)患者合并多支冠状动脉夹层。TIMI血流3级22处(78.6%)病变血管中有6处行血运重建治疗,而TIMI血流小于3级的6处病变中有4处行血运重建治疗。初始血运重建策略为经皮冠状动脉介入治疗(PCI)的患者6例(25.0%),冠状动脉旁路移植术和溶栓治疗均为2例(8.3%),余14例(58.3%)患者给予药物保守治疗。21例患者成功进行随访,随访时间中位数为31个月,发生主要不良心脑血管事件1例(4.2%,脑梗死)。结论:SCAD患者经常以急性冠状动脉综合征起病,多数患者可以选择药物保守治疗。

Objectives: To discuss the treatment strategy for spontaneous coronary artery dissection(SCAD) by retrospectively analyzing the clinical characteristics of SCAD patients.Methods: From January 2004 to November 2017, 58 patients were diagnosed with coronary artery dissection in the medical records system of Fuwai Hospital and 24 patients were defined as SCAD. The clinical data, angiographic features and follow-up results were investigated.Results: 24 SCAD patients were retrospectively reviewed. Average age was 48.1±13.3 years and 33.3% were women.Acute coronary syndromes(ACS) were presented in 75.0% of the enrolled SCAD patients. 28 dissection lesions were detected through coronary angiography and were all type 1 according to the SCAD classification. Right coronary arteries were involved in 53.6%(n=15) lesions and multivessel dissections were found in 16.7%(n=4) patients. 22 vessels(78.6%) were thrombolysis in myocardial infarction(TIMI) grade 3 flow and 6 underwent revascularization, revascularization was also performed in 4 out of 6 vessels with TIMI flow less than 3 grade. Percutaneous coronary intervention(PCI) was considered as the initial revascularization strategy in 25.0%(n=6) patients, meanwhile, coronary artery bypass grafting surgery plus thrombolytic therapy was performed in 8.3%(n=2) patients. Other patients underwent conservative therapy(n=14). Follow up was completed in 21 patients. The median follow-up time was 31 months, and overall major adverse cardiac and cerebrovascular events rate was 4.2%(one patient developed cerebral infarction).Conclusions: SCAD patients often present with ACS and conservative therapy could be a choice for most of the SCAD patients.