青年女性自发冠状动脉夹层导致急性心肌梗死1例并文献复习

Acute myocardial infarction caused by spontaneous coronary artery dissection in a young woman:A case report and literature review

目的探讨自发性冠状动脉夹层的临床特点,以期提高对该病的诊治与认识。方法回顾性分析1例青年女性自发性冠状动脉夹层导致急性心肌梗死患者的临床资料,并以“自发性冠状动脉夹层”、“急性心肌梗死”以及“青年女性”等关键词,通过检索中国知网、PubMed及万方数据库,筛选公开发表的相关中英文文献,以分析自发性冠状动脉夹层的临床特点。结果本例为青年女性,35岁,因间断胸痛就诊,心电图检查提示I、aVL及V2-V5导联ST段抬高,肌钙蛋白T升高(>2000 ng/L),冠状动脉造影结果示左主干(LM)自开口可见夹层,延伸至左前降支(LAD)远段及回旋支(LCX)中段,管腔全程受压,近段血管部分不能显影,经血管内超声(intravenous ultrasound,IVUS)指导下行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗,随访1个月并复查冠状动脉造影(coronary angiography,CAG)患者治疗效果良好。结论自发性冠状动脉夹层是导致急性冠脉综合征的罕见病因,其疾病特点及治疗方法与冠状动脉粥样硬化不同,诊断具有挑战性,临床易误诊误治,因此对于年轻急性冠状动脉综合征(acute coronary syndrome,ACS)患者需要考虑自发性冠状动脉夹层可能。

Objective To explore the clinical characteristics of spontaneous coronary artery dissection,aiming to improve the diagnosis and treatment of this disease.Methods The clinical data of a young female patient with acute myocardial infarction caused by spontaneous coronary artery dissection were retrospectively analyzed.In addition,relevant Chinese and English language literatures were searched in the CNKI,PubMed and Wanfang databases using the keywords of“spontaneous coronary artery dissection”,“acute myocardial infarction”and“young female”to perform literature review.Results A 35-year-old young woman presented in our hospital with an intermittent chest pain.Electrocardiography showed ST-segment elevation in leads I,aVL and V2-V5.Troponin T was elevated(>2000 ng/L).Coronary angiography(CAG)showed that the left main stem(LM)was dissected from the opening,which was extended to the distal segment of the left anterior descending branch(LAD)and the middle part of the left circumflex branch(LCX).The lumen was under pressure throughout the whole process,and the proximal vessels were unable to be visualized.Percutaneous coronary intervention(PCI)was performed under the guidance of intravenous ultrasound(IVUS).At the 1-month follow-up visit,CAG showed a good therapeutic effect.Conclusion Spontaneous coronary dissection is a rare cause of acute coronary syndrome,and its disease characteristics and treatment methods are different from those of coronary atherosclerosis.The diagnosis is challenging and it is easy to be misdiagnosed and mistreated clinically.Therefore,the possibility of spontaneous coronary dissection should be considered in young patients with ACS.