自发性冠状动脉夹层的临床结果

M. García-Guimarães, M. Masotti, R. Sanz-Ruiz, F. Macaya, G. Roura, J. Nogales, H. Tizón-Marcos, Maite Velázquez-Martín, G. Veiga, X. Flores-Ríos, Omar Abdul-Jawad Altisent, M. Jiménez-Kockar, S. Camacho-Freire, J. Moreu, S. Ojeda, S. Santos-Martínez, A. Sanz-García, D. del Val, T. Bastante, F. Alfonso
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Major adverse cardiovascular and cerebrovascular event (MACCE) was predefined as composite of death, myocardial infarction, unplanned revascularisation, SCAD recurrence or stroke. All events were assigned by a Clinical Events Committee. Results After corelab evaluation, 389 patients were included. Most patients were women (88%); median age 53 years (IQR 47–60). Most patients presented as non-ST-segment-elevation myocardial infarction (54%). A type 2 intramural haematoma (IMH) was the most frequent angiographic pattern (61%). A conservative initial management was selected in 78% of patients. At a median time of follow-up of 29 months (IQR 17–38), 46 patients (13%) presented MACCE, mainly driven by reinfarctions (7.6%) and unplanned revascularisations (6.2%). 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引用次数: 12

摘要

目的自发性冠状动脉夹层(SCAD)是急性冠状动脉综合征的罕见病因。我们的目的是评估全国前瞻性队列随访时的不良事件。方法西班牙SCAD登记处(SR-SCAD)包括来自34家医院的患者。两位专家对所有冠状动脉造影照片进行了分析。那些对SCAD的诊断有疑问的病例被排除在外。遵循Saw等人的血管造影SCAD分类。主要心脑血管不良事件(MACCE)被预先定义为死亡、心肌梗死、计划外血运重建、SCAD复发或中风的复合事件。所有事件均由临床事件委员会指定。结果经corelab评估,共纳入389例患者。大多数患者为女性(88%);中位年龄53岁(IQR 47-60)。大多数患者表现为非ST段抬高型心肌梗死(54%)。2型壁内血肿(IMH)是最常见的血管造影模式(61%)。78%的患者选择了保守的初始治疗。中位随访时间为29个月(IQR 17-38),46名患者(13%)出现MACCE,主要由再梗死(7.6%)和计划外血运重建(6.2%)引起。既往甲状腺功能减退史(HR 3.79;p<0.001)、近端血管受累史(HR 2.69;p=0.009),2型IMH(HR 2.12;p=0.037)和出院时双重抗血小板治疗(DAPT)(HR 2.18;p=0.042)是MACCE的独立预测因素。结论在这个庞大的SCAD患者前瞻性队列中,预后总体良好,事件主要由再梗死或计划外血运重建引起。甲状腺功能减退史、近端血管受累、2型IMH和出院时DAPT与MACCE相关。试验注册号NCT03607981。
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Clinical outcomes in spontaneous coronary artery dissection
Objective Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome. Our aim was to assess adverse events at follow-up from a nationwide prospective cohort. Methods The Spanish Registry on SCAD (SR-SCAD) included patients from 34 hospitals. All coronary angiograms were analysed by two experts. Those cases with doubts regarding the diagnosis of SCAD were excluded. The angiographic SCAD classification by Saw et al was followed. Major adverse cardiovascular and cerebrovascular event (MACCE) was predefined as composite of death, myocardial infarction, unplanned revascularisation, SCAD recurrence or stroke. All events were assigned by a Clinical Events Committee. Results After corelab evaluation, 389 patients were included. Most patients were women (88%); median age 53 years (IQR 47–60). Most patients presented as non-ST-segment-elevation myocardial infarction (54%). A type 2 intramural haematoma (IMH) was the most frequent angiographic pattern (61%). A conservative initial management was selected in 78% of patients. At a median time of follow-up of 29 months (IQR 17–38), 46 patients (13%) presented MACCE, mainly driven by reinfarctions (7.6%) and unplanned revascularisations (6.2%). Previous history of hypothyroidism (HR 3.79; p<0.001), proximal vessel involvement (HR 2.69; p=0.009), type 2 IMH (HR 2.12; p=0.037) and dual antiplatelet therapy (DAPT) at discharge (HR 2.18; p=0.042) were independent predictors of MACCE. Conclusions In this large prospective cohort of patients with SCAD, prognosis was overall favourable, with events mainly driven by reinfarctions or unplanned revascularisations. History of hypothyroidism, proximal vessel involvement, type 2 IMH and DAPT at discharge were associated with MACCE. Trial registration number NCT03607981.
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