中国临床医学2018，Vol.25Issue(2)：188-193,6.DOI:10.12025/j.issn.1008-6358.2018.20170683
基于单中心的中国人群自发性冠状动脉夹层临床特征与治疗策略
Clinical characteristic and therapy strategy of spontaneous coronary artery dissection based on single-center experience in China
摘要
Abstract
Objective: To describe the incidence,clinical characteristics,therapy strategy and outcomes of spontaneous coronary artery dissection based on single-center experience in China.Methods:We performed retrospective case-identification study in 16 526 patients underwent coronary angiography in Zhongshan Hospital of Fudan University between March 2015 to December 2016,and identified 17 patients with spontaneous coronary artery dissection.Risk factors,clinical features,angiographic features,therapy strategy,and clinical outcomes were analyzed.Results:The incidence of SCAD was 17 of 16 526(1.03/1 000).The mean age was(49.06 ± 10.73)years old(range:26-67 years old).In these 17 cases,4 cases were males,and others were females.Females constituted 13 of 17(76.5%).All SCAD patients presented with acute coronary syndrome,including 10 patients with acute ST-elevated myocardial infarction,3 patients with acute non-ST-elevated myocardial infarction and 4 patients with unstable angina.Twenty dissection sites were identified in 17 SCAD patients. Dissection was predominantly located at the left descending artery(50%)and the right coronary artery(35%).All lesions fell into three types:type Ⅰ(n=5),type Ⅱ A(n= 7),type ⅡB(n= 6),and type Ⅲ(n= 2).The TIMI flow in the distal segment of the coronary dissection was classified as follows:class 0(n=4),class 1(n=2),class 3(n=14).Conservative medical treatment was adopted by 7 of 17(41.1%)patients,and percutaneous transluminal coronary angioplasty(PTCA)in 1 of 17(5.9%)patients.No recurrent angina and other cardiovascular events was observed during clinical follow up. Percutaneous coronary intervention(PCI)was performed in 9 of 17(52.9%)patients,and the mean number of deployed stent was(2.44 ± 1.13).Intramural hematoma was extended during PCI in 5 of 9(55.6%)patients,resulting in new-onset nonfatal myocardial infarction in one patient and cardiac death in another patient.Conclusions:SCAD should be considered in young and middle-aged female patients presented with acute coronary syndrome,especially in those with few coronary risk factors. Interventional cardiologist should be familiar with the angiographic characteristics of SCAD,and turn to intravascular ultrasound if necessary.Conservative treatment should be the first choice in most patients with SCAD,while PCI intervention could be considered in high risk patients.Be caution to prevent interventional complications such as dissection expansion in the patients with high-risk.关键词
自发性冠状动脉夹层/急性冠脉综合征/经皮冠状动脉介入治疗/血管内超声Key words
spontaneoucoronararterdissection/acutcoronarsyndrome/percutaneoucoronarintervention/intravasculaultrasound分类
医药卫生引用本文复制引用
黄浙勇,马剑英,姚康,张峰,王齐兵,钱菊英,葛均波,杨虹波,宋亚楠,石洪涛,戴宇翔,李晨光,陆浩,徐世坤,黄东..基于单中心的中国人群自发性冠状动脉夹层临床特征与治疗策略[J].中国临床医学,2018,25(2):188-193,6.基金项目
国家重点研发计划(2016YFC1301200),国家自然科学基金(81370003,81570223).Supported by National Key Research and Development Project of China(2016YFC1301200)and National Natural Science Foundation of China(81370003,81570223). （2016YFC1301200）
