Spontaneous Coronary Artery Dissection as a Cause of Acute Myocardial Infarction in Young Female Population: A Single-center Study.
Spontaneous Coronary Artery Dissection as a Cause of Acute Myocardial Infarction in Young Female Population: A Single-center Study.
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DOI：
10.4103/0366-6999.208245
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发表时间：
2017-07-05
影响因子：
6.1
通讯作者：
Ye F
中科院分区：
文献类型：
--
作者：
Meng PN;Xu C;You W;Wu ZM;Xie DJ;Zhang H;Pan C;Ye F
自发性冠状动脉夹层（SCAD）是一种罕见且危险的非动脉粥样硬化性临床疾病，在年轻女性急性心肌梗死（AMI）患者中发病率很高。之前的报告仅限于其他国家的人口，但在中国很少见。因此，本研究旨在关注SCAD作为中国江苏年轻女性AMI人群病因的特征。本研究招募年龄≤50岁的年轻女性AMI患者，于2013年1月至2016年12月在我中心行冠状动脉造影（CAG）及冠状动脉内成像。分析其临床表现、危险因素及CAG特征。共纳入60例年轻女性AMI（<7天）患者。从CAG和冠状动脉内成像结果来看，年轻女性AMI人群中SCAD的患病率为35%(21/60)，冠状动脉粥样硬化性心脏病的患病率为65%（39/60）。在SCAD组中，43%（9/21）表现为非st段抬高型心肌梗死（NSTEMI），其余表现为STEMI。SCAD多发生于单支血管（20/21,95%），尤以左前降支为多（14/21,67%）。保守治疗18例（18/21,86%），经皮冠状动脉介入治疗3例（3/21,14%）。SCAD病变血管造影结果中，膜内血肿鉴别率为95% (20/21)，I型鉴别率为5% (1/21)，II型鉴别率为67% (14/21)，III型鉴别率为29%（6/21）。本组平均狭窄率为76.9%±20.6%，平均病变长度为36.6±8.6 mm。SCAD在中国江苏年轻女性AMI人群中患病率较高。鉴别年轻女性AMI发病原因具有重要意义。
Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic but a rare and extremely dangerous clinical entity, it has a high prevalence in young female population with acute myocardial infarction (AMI). The previous reports were restricted to other countries’ population, but rare in China. Hence, this study aimed to focus on the characteristics of SCAD as a cause of young female AMI population in Jiangsu, China. This study enrolled young female AMI patients aged ≤50 years who underwent coronary angiography (CAG) and intracoronary imaging in our center between January 2013 and December 2016. Their clinical presentations, risk factors, and CAG characteristics were analyzed. A total of 60 young female AMI (<7 days) patients were enrolled. From their CAG and intracoronary imaging results, the prevalence of SCAD in young female AMI population was 35% (21/60), the prevalence of coronary atherosclerostic heart disease was 65% (39/60). In the SCAD group, 43% (9/21) presented with non-ST-elevation myocardial infarction (NSTEMI) and the remainder presenting as STEMI. SCAD usually occurred in a single vessel (20/21, 95%), especially in left anterior descending artery (14/21, 67%). Eighteen patients (18/21, 86%) underwent conservative treatment, whereas the remaining three patients (3/21, 14%) underwent percutaneous coronary intervention. Regarding the angiographic results of SCAD lesions, intramural hematoma was discriminated in 95% (20/21), and Type I imaging was observed in 5% (1/21), Type II was observed in 67% (14/21), and Type III was 29% (6/21). The average stenosis in the group was 76.9% ± 20.6%, and the mean lesion length was 36.6 ± 8.6 mm. SCAD has a high prevalence in young female AMI population in Jiangsu, China. Discriminating the cause of AMI in young female population is very important.