Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection
Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection
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DOI：
10.1016/j.amjcard.2015.03.039
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发表时间：
2015-07-01
影响因子：
2.8
通讯作者：
Castiglioni, Battistina
中科院分区：
文献类型：
--
作者：
Lettieri, Corrado;Zavalloni, Dennis;Castiglioni, Battistina
自发性冠状动脉夹层（SCAD）的最佳管理和短期和长期治疗仍然没有很好的定义。这项观察性多中心研究的目的是评估SCAD患者的长期临床结局。在134例有记录的SCAD患者中评估了院内和长期结局，以及保守治疗而非血运重建治疗策略的临床影响和预测因素。平均年龄为52 ± 11岁，81%的患者为女性。93%的SCAD患者表现为急性冠脉综合征。58%的患者接受保守治疗，42%的患者接受血运重建。在多变量分析中，远端与近端或中间夹层位置（比值比9.27）和心肌梗死基础溶栓（TIMI）血流分级2或3级与0或1级（比值比0.20）是保守与血运重建策略的独立预测因素。与血运重建相比，保守策略与更好的院内结局相关（主要不良心脏事件发生率分别为3.8%和16.1%，p = 0.028）;然而，在长期结局方面未观察到显著差异。总之，在这项SCAD患者的大型观察性研究中，血管造影特征显著影响了治疗策略，提供了良好的短期和长期预后。(C)2015爱思唯尔公司All rights reserved.
The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis. (C) 2015 Elsevier Inc. All rights reserved.