Management of spontaneous coronary artery dissection: Trends over time.
Management of spontaneous coronary artery dissection: Trends over time.
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DOI：
10.1177/1358863x231155305
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发表时间：
2023-04
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自发性冠状动脉夹层(SCAD)是引起急性冠脉综合征的一个日益公认的原因。在过去的10年里，关于SCAD患者最佳治疗的指南已经发表，但对临床实践的影响还没有被评估。本研究旨在检查侵入性管理、医学治疗和血管成像的方法是否随着时间的推移而改变。这是一项对2005年至2019年在宾夕法尼亚州费城一个学术卫生系统接受SCAD治疗的157名患者的回顾性队列研究。我们的目标是检查随着时间的推移管理的变化，包括冠状动脉血管重建率、出院药物和血管成像。随着时间的推移，SCAD的保守管理比例从2013年之前的35%上升到2019年的89%，p<；0.001。血运重建与年龄较小、妊娠相关的SCAD以及左主干、左前降支和多支血管病变有关，P<；0.05。冠状动脉外血管异常的部分显像率从2013年之前的33%到2018年的71%，p=0.146。在所有时间类别中，综合血管成像(横断面头部和骨盆成像)的比率仍然很低(10%-18%)，并且不随时间变化。接受全面成像的患者比部分成像的患者更有可能被诊断为纤维肌肉发育不良(63%比15%，p<；0.001)。自发性冠状动脉夹层的处理随着时间的推移而改变。更多的患者正在接受保守治疗，并接受冠状动脉外血管异常的筛查，如FMD。未来的努力应该集中在提高全面血管筛查率上。
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome. Guidance regarding the optimal management of patients with SCAD has been published over the past 10 years, but the impact on clinical practice has not been evaluated. The present study aims to examine if approaches to invasive management, medical therapy, and vascular imaging have changed over time. This is a retrospective cohort study of 157 patients treated for SCAD between 2005 and 2019 at an academic health system in Philadelphia, Pennsylvania. We aimed to examine change in management over time, including rates of coronary revascularization, discharge medications, and vascular imaging. Conservative management of SCAD increased over time from 35% before 2013 to 89% in 2019, p < 0.001. Revascularization was associated with younger age, pregnancy-associated SCAD, and lesions of the left main artery, left anterior descending artery, and multiple vessels, p < 0.05 for all. Partial imaging for extracoronary vascular abnormalities ranged from 33% before 2013 to 71% in 2018, p = 0.146. The rate of comprehensive vascular imaging (cross-sectional head to pelvis imaging) remained low in all time categories (10–18%) and did not change over time. Patients who underwent comprehensive imaging were more likely to be diagnosed with fibromuscular dysplasia (FMD) compared to those with partial imaging (63% vs 15%, p < 0.001). Management of spontaneous coronary artery dissection has changed over time. More patients are being managed conservatively and undergo screening for extracoronary vascular abnormalities such as FMD. Future efforts should focus on improving rates of comprehensive vascular screening.