| Clinical characteristic and therapy strategy of spontaneous coronary artery dissection based on single-center experience in China |
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| Citation of this paper:HUANG Zhe-yong, YANG Hong-bo, SONG Ya-nan, SHI Hong-tao, DAI Yu-xiang, LI Chen-guang, LU Hao, XU Shi-kun, HUANG Dong, MA Jian-ying, YAO Kang, ZHANG Feng, WANG Qi-bing, QIAN Ju-ying, GE Jun-bo*.Clinical characteristic and therapy strategy of spontaneous coronary artery dissection based on single-center experience in China[J].Chinese Journal of Clinical Medicine,2018,25(2):188-193 |
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| Author Name | Affiliation | | HUANG Zhe-yong, YANG Hong-bo, SONG Ya-nan, SHI Hong-tao, DAI Yu-xiang, LI Chen-guang, LU Hao, XU Shi-kun, HUANG Dong, MA Jian-ying, YAO Kang, ZHANG Feng, WANG Qi-bing, QIAN Ju-ying, GE Jun-bo* | Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China |
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| Abstract:Objective：To describe the incidence, clinical characteristics, therapy strategy and outcomes of spontaneous coronary artery dissection based on single-center experience in China. Methods：We performed retrospective case-identification study in 16 526 patients underwent coronary angiography in Zhongshan Hospital of Fudan University between March 2015 to December 2016, and identified 17 patients with spontaneous coronary artery dissection. Risk factors, clinical features, angiographic features, therapy strategy, and clinical outcomes were analyzed. Results：The incidence of SCAD was 17 of 16 526 (1.03/1 000). The mean age was (49.06 ± 10.73) years old (range: 26-67 years old ). In these 17 cases, 4 cases were males, and others were females. Females constituted 13 of 17 (76.5%). All SCAD patients presented with acute coronary syndrome, including 10 patients with acute ST-elevated myocardial infarction, 3 patients with acute non-ST-elevated myocardial infarction and 4 patients with unstable angina. Twenty dissection sites were identified in 17 SCAD patients. Dissection was predominantly located at the left descending artery (50%) and the right coronary artery (35%). All lesions fell into three types: type Ⅰ (n=5), type Ⅱ A (n=7), type ⅡB (n=6), and type Ⅲ (n=2). The TIMI flow in the distal segment of the coronary dissection was classified as follows: class 0 (n=4), class 1 (n=2), class 3 (n=14).Conservative medical treatment was adopted by 7 of 17 (41.1%) patients, and percutaneous transluminal coronary angioplasty (PTCA) in 1 of 17 (5.9%) patients. No recurrent angina and other cardiovascular events was observed during clinical follow up. Percutaneous coronary intervention (PCI) was performed in 9 of 17 (52.9%) patients, and the mean number of deployed stent was (2.44±1.13). Intramural hematoma was extended during PCI in 5 of 9 (55.6%) patients, resulting in new-onset nonfatal myocardial infarction in one patient and cardiac death in another patient. Conclusions：SCAD should be considered in young and middle-aged female patients presented with acute coronary syndrome, especially in those with few coronary risk factors. Interventional cardiologist should be familiar with the angiographic characteristics of SCAD, and turn to intravascular ultrasound if necessary. Conservative treatment should be the first choice in most patients with SCAD, while PCI intervention could be considered in high risk patients. Be caution to prevent interventional complications such as dissection expansion in the patients with high-risk. |
| keywords:spontaneous coronary artery dissection acute coronary syndrome percutaneous coronary intervention intravascular ultrasound |
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