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冠状动脉自发夹层之流行病学现状及疾病管理
CBSMD
冠状动脉自发夹层(Spontaneouscoronary artery dissection,SCAD)是ACS、心肌梗死和心脏猝死的重要元凶之一,尤其是对青年到中年女性而言。观察性研究报告了冠状动脉外血管异常(extracoronary vascular anomalies)的高发生率,尤其是纤维肌异常增生(fibromuscular dysplasia,FMD)和动脉粥样硬化的低患病率率。
进行中的SCAD基础研究热点
2019年1月“Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Coronary Artery Dissection”使用迄今为止最大的荟萃分析数据(N=1055 SCAD patients and 7190 controls)验证了FMD基因型rs9349379与SCAD之间的联系可能导致临床症状的重叠。
专属评论文章“Linking Spontaneous Coronary Artery Dissection, Cervical Artery Dissection, and Fibromuscular Dysplasia: Heart, Brain, and Kidneys”。
2019年3月“Prevalence of Coronary Vasospasm Using Coronary Reactivity Testing in Patients With Spontaneous Coronary Artery Dissection”在克利夫兰诊所对27年间单中心经造影明确的女性SCAD患者群进行回顾性分析,从冠脉痉挛(Coronary vasospasm )的发生率过低的角度,否定了两者之间存在的相关性。
SCAD疾病管理指南
2019年3月AHA 最新科学声明“Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association”涉及了SCAD的鉴别诊断及疾病管理策略。
影像学指导诊断SCAD
2013年7月“Combined use of OCT and IVUS in spontaneous coronary artery dissection” 推荐了使用腔内影像学OCT和IVUS各自的影像学优势联合明确SCAD诊断的方法,并指出在常规无异常造影的表象下的SCAD呈现在OCT和IVUS下的影像学特点。
2018年9月“Early Natural History of Spontaneous Coronary Artery Dissection”采用回顾性造影对照比较患者14天前后疾病进展对比结果揭示了SCAD病情发展所伴随的壁内血肿(Intramuralhematoma,IMH)、病灶纵向发展方面的影像学证据。明确了保守治疗SCAD或增加疾病进程以6天为时间界限的危险比。观察到IMH通常先于内膜夹层(intimal dissection)的发展,这对SCAD的机制研究有一定的意义。
2019年3月“Spontaneous Coronary Artery Dissection: Pathophysiological Insights From Optical Coherence Tomography”呈现了OCT评估SCAD的影像学表现。
2019年3月“Natural History of Spontaneous Coronary Artery Dissection With Spontaneous Angiographic Healing”提供了156名SCAD患者≥30天前后复查造影变化数据:
1)前后病变狭窄程度的改变
2)<50%的残余狭窄
3)TIMI3血流
指出,其中95%的患者经造影明确可自愈。
SCAD临床预后
2019年4月“Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes”发布了2014-2018年间22家北美多中心、前瞻性观察性研究提供了750名无动脉粥样硬化SCAD(non-atherosclerotic SCAD)患者的患者群体特征、临床表现、造影特点、保守疗法和PCI疗法比例、院内期间主要不良事件(in-hospital major adverse events,MAE)和30天主要不良心血管事件( 30-day major adverse cardiovascular events , MACE)。总结出结缔组织病变(connective tissue disease)是女性围产期SCAD(Peripartum SCAD)患者30天MACE的独立预测因子。
2019年4月“Trends of Incidence, Clinical Presentation, and In-Hospital Mortality Among Women With Acute Myocardial Infarction With or Without Spontaneous Coronary Artery Dissection: A Population-Based Analysis”发布了女性AMI患者罹患SCAD的患病率、临床表现及死亡数据。
Prevalence of Coronary Vasospasm Using Coronary Reactivity Testing in P...
Am J Cardiol. | Apr 19,2019
Natural History of Spontaneous Coronary Artery Dissection With Spontaneo...
JACC Cardiovasc Interv. | Apr 19,2019
Canadian spontaneous coronary artery dissection cohort study: in-hospital and 3...
Eur Heart J. | Apr 19,2019
Contemporary Diagnosis and Management of Patients With Myocardial Infarc...
Circulation. | Apr 09,2019
Spontaneous Coronary Artery Dissection: Pathophysiological Insights From ...
JACC Cardiovasc Imaging. | Apr 19,2019
Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Co...
J Am Coll Cardiol. | Apr 19,2019
Early Natural History of Spontaneous Coronary Artery Dissection
Circ Cardiovasc Interv. | Apr 21,2019
Trends of Incidence, Clinical Presentation, and In-Hospital Mortality Amo...
JACC Cardiovasc Interv. | Apr 19,2019
Combined use of OCT and IVUS in spontaneous coronary artery dissection
JACC Cardiovasc Imaging. | Apr 21,2019
Linking Spontaneous Coronary Artery Dissection, Cervical Artery Dissecti...
J Am Coll Cardiol. | Apr 19,2019