Objective: To investigate the characteristics of acute myocardial infarction caused by spontaneous coronary artery dissection(SCAD) in young female patients. Methods: In this casecontrolstudy,127 young(≤55 years) female patients with acute myocardial infarction onset within 1 week in Nanjing first hospital, Xuzhou central hospital, affiliated hospital of Xuzhou medical university, and Lianyungang first people's hospital were enrolled between January 2013 and February 2017,and the clinical data were retrospectively analyzed. According to their clinical manifestations and coronary angiography(CAG) results,the patients were divided into coronary atherosclerosis disease(CAD) group(CAG evidenced atherosclerosis, n=83) and SCAD group(CAG detected coronary artery dissection,n=44).The SCAD patients were subdivided into definite group (the results affirmed from intravenous ultrasound or optical coherence tomography, n=21) and probable group (the CAG results highly confirmed to characteristics of SCAD,but no intravenous ultrasound or optical coherence tomography image affirmation,n=23). Then, according to the different treatment strategies, the SCAD patients were subdivided into conservative treatment group(treated with drugs,n=19) and interventional therapy group(treated with percutaneous coronary intervention,n=25). Results: (1)Compared to CAD group, patients in the SCAD group had less risk factors, such as hypertension history (25.0% (11/44) vs. 45.8% (38/83) , P=0.022) and diabetes history (6.8% (3/44) vs. 21.7% (18/83) , P=0.043),and had lower levels of fasting blood glucose (5.34(4.59,5.87) mmol/L vs. 7.12(5.18,8.60)mmol/L, P=0.001),total cholesterol((3.94±1.14) mmol/L vs. (4.91±1.50) mmol/L, P=0.001),triglyceride(1.42 (0.91,1.64) mmol/L vs. 1.89 (1.23,2.45) mmol/L, P=0.005),and low density lipoprotein cholesterol ((2.24±0.91) mmol/L vs. (2.94±1.16) mmol/L, P=0.001),CAG results showed that patients in the SCAD group had more single vessel lesion (88.6% (39/44) vs. 39.8% (33/83) , P=0.001), and their target lesion stenosis was less severe ( (79.2±22.4) % vs. (91.5±12.1) %, P=0.001). (2) The clinical risk factors such as hypertension history, diabetes history, smoking history, family history of cardiology disease, fasting blood glucose,total cholesterol,triglyceride and low density lipoprotein cholesterol were similar between definite group and probable group (all P>0.05). CAG results showed that prevalence of single vessel lesion (100% (21/21) vs. 78.3% (18/23) , P=0.050) and percent of target lesion stenosis ( (76.9±20.6) % vs. (81.2±24.1) %, P=0.529) were similar between definite group and probable group.(3)There were no significant difference in single vessel(84.0% (21/25) vs. 94.7% (18/19) , P=0.370), target lesion stenosis(85.0(70.0,100.0)% vs. 75.0(50.0,90.0)%, P=0.186),and survival rates in hospital(96.0% (24/25) vs. 100% (19/19) , P=1.000) between interventional therapy group and conservative treatment group. Conclusions: Prevalence of SCAD is highin young female patients with acute myocardial infarction. Acute myocardial infarction patients with less risk factors of CAD and with CAG showing smooth lesion of narrowing segment and normal finding in the other vessels, are more likely to be diagnosed with SCAD.Acute myocardial infarction patients caused by SCAD have high survival rate either receiving percutaneous coronary intervention or drug treatment.
目的： 探讨自发性冠状动脉夹层（SCAD）导致年轻女性急性心肌梗死的临床特点。 方法： 采用病例对照研究方法，入选2013年1月至2017年2月在江苏省4家医院（包括南京医科大学附属南京医院、徐州市中心医院、徐州医科大学附属医院和连云港市第一人民医院）住院且发病时间在1周以内的年轻（≤55岁）女性急性心肌梗死患者127例，对其临床资料进行回顾性分析。依据临床表现和冠状动脉造影结果，将入选患者分为冠心病组（符合冠状动脉动脉粥样硬化表现，共83例）和SCAD组（符合SCAD特点，共44例）。冠状动脉夹层患者进一步分为确诊组（光学相干断层成像或血管内超声证实为SCAD，共21例）和极可能组（冠状动脉造影结果高度符合SCAD特点，但缺乏光学相干断层显像或血管内超声证实，共23例）。根据患者的治疗方案不同，将SCAD患者分为保守治疗组（接受药物治疗，共19例）和介入治疗组（接受经皮冠状动脉介入治疗，共25例）。 结果： （1）与冠心病组比较，SCAD组有高血压病史[25.0%（11/44）比45.8%（38/83），P=0.022]和糖尿病史[6.8%（3/44）比21.7%（18/83），P=0.043]的比例均较低，空腹血糖[5.34（4.59,5.87）mmol/L比7.12（5.18,8.60）mmol/L，P=0.001]、总胆固醇[（3.94±1.14）mmol/L比（4.91±1.50）mmol/L，P=0.001]、甘油三酯[1.42（0.91,1.64）mmol/L比1.89（1.23,2.45）mmol/L，P=0.005]和低密度脂蛋白胆固醇[（2.24±0.91）mmol/L比（2.94±1.16）mmol/L，P=0.001]水平均较低，冠状动脉造影显示SCAD组单支病变比例较高[88.6%（39/44）比39.8%（33/83），P=0.001]且病变狭窄程度较轻[（79.2±22.4）%比（91.5±12.1）%，P=0.001]。（2）确诊组与极可能组的危险因素（包括有高血压病史、糖尿病史、吸烟史、心血管病家族史、空腹血糖、总胆固醇、甘油三酯和低密度脂蛋白胆固醇水平）差异均无统计学意义（P均>0.05）。确诊组与极可能组的冠状动脉单支病变比例[100%（21/21）比78.3%（18/23），P=0.050]和靶病变狭窄程度[（76.9±20.6）%比（81.2±24.1）%，P=0.529]差异均无统计学意义。（3）介入治疗组与保守治疗组的冠状动脉单支病变比例[84.0%（21/25）比94.7%（18/19），P=0.370]、靶病变狭窄率[85.0（70.0,100.0）%比75.0（50.0,90.0）%，P=0.186]和院内存活率[96.0%（24/25）比100%（19/19）, P=1.000]差异均无统计学意义。 结论： SCAD在年轻女性急性心肌梗死患者中发病率较高；对于危险因素较少的年轻女性急性心肌梗死患者，冠状动脉造影显示狭窄病变段较光滑且其他血管无动脉粥样硬化特点时，高度提示存在SCAD；不管是采取介入治疗还是药物保守治疗，SCAD导致急性心肌梗死患者的院内存活率均很高。.
Keywords: Coronary artery dissection; Female; Myocardial infarction.