自发冠状动脉剖析的临床特征,管理和预后
Marysia S Tweet1, Sharonne N Hayes, Sridevi R Pitta
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Circulation
|July 18, 2012
概括
自发冠状动脉解剖 (SCAD) 主要影响年轻女性,并经常呈现为心脏病发作. 长期风险包括复发和主要不良心脏事件,强调需要持续监测患者.
科学领域:
- 心脏病学 心脏病学
- 血管医学 血管医学
- 公共卫生 公共卫生
背景情况:
- 自发冠状动脉解剖 (SCAD) 是一种具有不明原因的急性冠状动脉综合征.
- 临床表现和SCAD的长期预后需要进一步的表征.
研究的目的:
- 评估SCAD的发病率,临床特征和结果.
- 评估与SCAD相关的住院和长期风险.
- 调查潜在的促成因素和相关疾病,如纤维肌肉发育不良.
主要方法:
- 追溯单中心队列研究87名血管学证实SCAD的患者.
- 评估患者的人口统计学,临床表现,治疗策略和住院事件.
- 对SCAD复发和主要不良心脏事件 (MACE) 的长期随访.
主要成果:
- SCAD主要影响年轻人 (平均年龄为42.6岁),其中82%为女性.
- 在男性中,极度劳动是更常见的触发因素,而在18%的女性中,发现了产后状态.
- 49%的病例呈现ST升高心肌梗塞;多血管SCAD发生在23%的病例中.
- 保守的管理和冠状动脉旁路移植有不复杂的在医院的课程.
- 穿皮冠状动脉干预 (PCI) 与35%的技术故障和1例死亡有关.
- 在47个月的中位数随访期间,SCAD复发发生在15名女性患者中.
- 估计的10年MACE率为47%.
- 纤维肌肉发育不良偶尔在50%的下动脉血管图和两名心动脉剖析的患者中被发现.
结论:
- SCAD影响年轻人,主要是女性人口,经常呈现为ST升高心肌梗塞.
- 虽然住院死亡率较低,但PCI具有显著的并发症风险.
- 由于SCAD复发和长期MACE的高发病率,需要密切跟踪患者.
- 纤维肌肉发育不良是一种新的关联和SCAD潜在的致病因素.
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