Left Main Spontaneous Coronary Artery Dissection

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-04-28 DOI:10.1016/j.jcin.2025.01.427

Michele Morosato MD , Carlo Gaspardone MD , Davide Romagnolo MD , Matteo Pagnesi MD , Luca Baldetti MD , Sara Dormio MD , Francesco Federico MD , Anna Mara Scandroglio MD , Alaide Chieffo MD , Cosmo Godino MD , Alberto Margonato MD , Marianna Adamo MD , Marco Metra MD , Didier Tchetche MD , Nicolas Dumonteil MD , Marysia S. Tweet MD, MS , Jacqueline Saw MD , Alessandro Beneduce MD

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引用次数: 0

Abstract

Background

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction (MI) and is associated with substantial adverse events. SCAD involving the left main coronary artery (LM) is a rare but potentially life-threatening condition. Currently, minimal data on LM SCAD have been reported.

Objectives

The aim of this study was to investigate clinical features, contemporary management, and clinical outcomes of patients with LM SCAD.

Methods

A systematic review and pooled analysis of published case reports was conducted using “left main” and “dissection” as keywords. The authors screened 1,106 papers in MEDLINE and Embase published between 1990 and 2023.

Results

The final analysis included 132 patients (mean age 40 ± 11 years, 80% women) diagnosed with LM SCAD. Remarkably, 36% of cases occurred during pregnancy, and 95% presented with acute coronary syndrome, 22% with cardiogenic shock, and 8% with ventricular arrhythmias. At 120-day median follow-up, all-cause death occurred in 9%, left ventricular assist device implantation or heart transplantation in 4%, recurrent MI in 13%, and urgent myocardial revascularization (MR) in 21%. Compared with conservative management, early revascularization by percutaneous coronary intervention or coronary artery bypass grafting significantly reduced the composite endpoint of all-cause death, left ventricular assist device implantation or heart transplantation, recurrent MI, and urgent MR (adjusted HR: 0.37; 95% CI: 0.20-0.69; P < 0.001).

Conclusions

LM SCAD carried significant acute morbidity and mortality. Early revascularization (percutaneous coronary intervention or coronary artery bypass graft) was associated with a lower incidence of early adverse outcomes compared with conservative management, driven largely by reduction in recurrent MI and urgent MR. These hypothesis-generating data should be confirmed in future prospective registries and clinical trials.

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左主干自发性冠状动脉夹层

背景：自发性冠状动脉夹层（SCAD）是一种罕见的急性心肌梗死（MI）原因，并与大量不良事件相关。SCAD累及左主干冠状动脉（LM）是一种罕见但可能危及生命的疾病。目前，关于LM SCAD的数据报道很少。目的本研究的目的是探讨LM SCAD患者的临床特征、当代管理和临床结果。方法以“左主干”和“解剖”为关键词，对已发表的病例报告进行系统回顾和汇总分析。作者筛选了1990年至2023年间在MEDLINE和Embase发表的1106篇论文。结果最终分析纳入132例确诊为LM SCAD的患者（平均年龄40±11岁，其中80%为女性）。值得注意的是，36%的病例发生在怀孕期间，95%出现急性冠状动脉综合征，22%出现心源性休克，8%出现室性心律失常。在120天的中位随访中，全因死亡发生率为9%，左心室辅助装置植入或心脏移植发生率为4%，复发性心肌梗死发生率为13%，紧急心肌血运重建术（MR）发生率为21%。与保守治疗相比，经皮冠状动脉介入治疗或冠状动脉旁路移植术的早期血运重建术显著降低了全因死亡、左心室辅助装置植入或心脏移植、心肌梗死复发和紧急MR的综合终点(调整后HR: 0.37；95% ci: 0.20-0.69；P & lt;0.001)。结论slm SCAD具有显著的急性发病率和死亡率。与保守治疗相比，早期血运重建术（经皮冠状动脉介入治疗或冠状动脉旁路移植术）与早期不良后果发生率较低相关，主要是由于复发性心肌梗死和紧急mr的减少。这些假设生成的数据应在未来的前瞻性登记和临床试验中得到证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.