自发性冠状动脉夹层所致急性冠状动脉综合征的临床与预后研究  

Analysis of clinical features and prognosis of acute coronary syndrome with spontaneous coronary artery dissection

作　　者：黄新亮 郭欣 李明亮[1] 王琦[1] 白晓君[2] 赵宽 陈强 高宏波[1] HUANG Xinliang;GUO Xin;LI Mingliang;WANG Qi;BAI Xiaojun;ZHAO Kuan;CHEN Qiang;GAO Hongbo(Department of Cardiology,Hanzhong People's Hospital,Hanzhong 723000,China)

机构地区：[1]汉中市人民医院心内科,723000 [2]西安交通大学第一附属医院心内科 [3]汉中市3201医院心内科 [4]解放军96605部队医院心内科

出　　处：《心肺血管病杂志》2021年第6期558-561,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析自发性冠状动脉夹层(SCAD)所致急性冠状动脉综合征(ACS)患者的临床资料,以积累该病的诊疗经验。方法:选择经冠状动脉造影(CAG)或冠状动脉影像学检查明确诊断为SCAD所致的ACS患者为研究对象,分析其病历资料和CAG资料,对其临床特征、冠状动脉影像学特征、治疗策略和随访结果进行分析。结果:共入选18例患者,其中ST段抬高型心肌梗死(STEMI)5例(27.7%),非ST段抬高型心肌梗死(NSTEMI)3例(16.7%),不稳定性心绞痛10例(55.6%);患者平均年龄(47.5±12,3)岁,其中女性13例(72.2%),合并2种以上冠心病危险因素的患者仅7例(38.9%);冠状动脉夹层的分型以1型病变10例(55.6%)为主,18例患者共发现23处夹层病变,5例(27.7%)合并多支冠状动脉夹层病变,其中12处(52.2%)病变累及前降支(LAD),7处(30.4%)病变累及旋支(LCX),4处(17.4%)病变累及右冠状动脉(RCA);患者治疗策略以药物保守治疗13例(72.2%)为主,经过12个月的随访,血运重建2例(11.1%),再次心肌梗死1例(5.6%),其余15例在随访中无任何严重主要不良心脑血管(MACCE)事件发生。结论:SCAD所致的ACS患者多为年轻女性,且合并冠心病危险因素较少,患者经药物保守治疗后近期预后良好。Objective:To analyze the medical records of patients in acute coronary syndrome(ACS)with spontaneous coronary artery dissection(SCAD),and accumulate experience in the treatment of the disease.Methods:Patients of ACS with SCAD were selected,and analyze the clinical characteristics,treatment strategies and follow-up result of the patients.Results:Eighteen cases of patients were selected,Including 5 cases of ST-segment elevation myocardial infarction(STEMI),3 cases of non-ST segment elevation myocardial infarction(NSTEMI)and 10 cases of unstable angina(55.6%);The average age of the patients is(47.5±12.3)years,Including 13 case of female(72.2%),there are 7 patients(38.9%)with more than two risk factors for coronary heart disease;Coronary artery disease is mainly type one dissection,5 cases combined with multiple coronary artery dissections,12 lesions involved the anterior descending artery,7 lesions involved the circumflex artery,and 4 lesions involved the right coronary artery;Patients are mainly given conservative treatment,after 12 months of fol-low-up,There were two patients with revascularization,one patient with recurrent myocardial infarction,and no major adverse cardiovascular and cerebrovascular events occurred in the remaining patients.Conclusions:patients of ACS with SCAD are mostly young women,it mostly occur in young women,and there are fewer risk factors for coronary heart disease,the prognosis of patients is good after conservative treatment with drugs.

关 键 词：自发性冠状动脉夹层 急性冠状动脉综合征 临床特征 

分 类 号：R54[医药卫生—心血管疾病]