Статья
Современные аспекты диагностики и лечения пациентов со спонтанной диссекцией коронарных артерий
Спонтанная диссекция коронарных артерий (СДКА) является одной из наиболее редких причин острого коронарного синдрома. СДКА чаще всего встречается у женщин <60 лет (≥90% случаев) в сравнении с мужчинами (10-12%). Бурное развитие технологий, применяемых в интервенционной кардиологии, позволило улучшить диагностику и понять механизм развития данного патологического состояния. Тактика ведения пациентов с СДКА дискутабельна и значительно отличается от подходов к лечению атеросклеротического поражения коронарных артерий. В обзоре представлены результаты проведенных в последние годы исследований. Также описана ангиографическая классификация СДКА, алгоритм диагностики и выбор оптимальной тактики лечения в зависимости от клинических проявлений.
1. Saw J, Starovoytov A, Humphries K, et al. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30day outcomes. Eur Heart J. 2019;40(15):1188-97. doi:10.1093/eurheartj/ehz007.
2. Combaret N, Gerbaud E, Dérimay F, et al. National French registry of spontaneous coronary artery dissections: prevalence of fibromuscular dysplasia and genetic analyses. EuroIntervention. 2021;17(6):508-15. doi:10.4244/eij-d-20-01046.
3. Mahmoud AN, Taduru SS, Mentias A, et al. 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. JACC Cardiovasc Interv. 2018;11(1):80-90. doi:10.1016/j.jcin.2017.08.016.
4. Pretty H. Dissecting aneurysm of coronary artery in a woman aged 42: rupture. BMJ. 1931;1:667.
5. Claudon DG, Claudon DB, Edwards J, et al. Primary dissecting aneurysm of coronary artery. A cause of acute myocardial ischemia. Circulation. 1972;45(2):259-66. doi:10.1161/01.CIR.45.2.259.
6. Adlam D, Alfonso F, Maas A, Vrints C, Writing Committee. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018;39(36):3353-68. doi:10.1093/eurheartj/ehy080.
7. Rashid HN, Wong DT, Wijesekera H, et al. Incidence and characterisation of spontaneous coronary artery dissection as a cause of acute coronary syndrome — A single-centre Australian experience. Int J Cardiol. 2016;202:336-8. doi:10.1016/j.ijcard.2015.09.072.
8. Nakashima T, Noguchi T, Haruta S, et al. Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan. Int J Cardiol. 2016;207:341-8. doi:10.1016/j.ijcard.2016.01.188.
9. Hill SF, Sheppard MN. Non-atherosclerotic coronary artery disease associated with sudden cardiac death. Heart 2010;96:1119-25. doi:10.1136/hrt.2009.185157.
10. Vanzetto G, Berger-Coz E, Barone-Rochette G, et al. Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients. Eur J Cardiothorac Surg. 2009;35(2):250-4. doi:10.1016/j.ejcts.2008.10.023.
11. Clare R, Duan L, Phan D, et al. Characteristics and Clinical Outcomes of Patients With Spontaneous Coronary Artery Dissection. J Am Heart Assoc. 2019;8(10):e012570. doi:10.1161/jaha.119.012570.
12. Hayes SN, Kim ESH, Saw J, et al. American Heart Association Council on Peripheral Vascular Disease; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Genomic and Precision Medicine; and Stroke Council. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation. 2018;137(19):e523-57. doi:10.1161/CIR.0000000000000564.
13. Saw J, Aymong E, Sedlak T, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014;7(5):645-55. doi:10.1161/CIRCINTERVENTIONS.114.001760.
14. Sharma S, Kaadan MI, Duran JM, et al. Risk Factors, Imaging Findings, and Sex Differences in Spontaneous Coronary Artery Dissection. Am J Cardiol. 2019;123(11):1783-7. doi:10.1016/j.amjcard.2019.02.040.
15. Tweet MS, Hayes SN, Codsi E, et al. Spontaneous Coronary Artery Dissection Associated With Pregnancy. J Am Coll Cardiol. 2017;70(4):426-35. doi:10.1016/j.jacc.2017.05.055.
16. Havakuk O, Goland S, Mehra A, et al. Pregnancy and the Risk of Spontaneous Coronary Artery Dissection: An Analysis of 120 Contemporary Cases. Circ Cardiovasc Interv. 2017;10(3):e004941. doi:10.1161/CIRCINTERVENTIONS.117.004941.
17. Elkayam U, Jalnapurkar S, Barakkat MN, et al. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation. 2014;129(16):1695702. doi:10.1161/CIRCULATIONAHA.113.002054.
18. Farmer RD, Lawrenson RA. Oral contraceptives and venous thromboembolic disease: the findings from database studies in the United Kingdom and Germany. Am J Obstet Gynecol. 1998;179(3 Pt 2):S78-86. doi:10.1053/ob.1998.v179.a92634.
19. Tweet MS, Hayes SN, Pitta SR, et al. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012;126(5):579-88. doi:10.1161/CIRCULATIONAHA.112.105718.
20. Motreff P, Malcles G, Combaret N, et al. How and when to suspect spontaneous coronary artery dissection: novel insights from a single-centre series on prevalence and angiographic appearance. EuroIntervention. 2017;12(18):e2236-43. doi:10.4244/eij-d-16-00187.
21. Luong C, Starovoytov A, Heydari M, et al. Clinical presentation of patients with spontaneous coronary artery dissection. Catheter Cardiovasc Interv. 2017;89(7):1149-54. doi:10.1002/ccd.26977.
22. Hassan S, Prakash R, Starovoytov A, et al. Natural History of Spontaneous Coronary Artery Dissection With Spontaneous Angiographic Healing. JACC Cardiovasc Interv. 2019;12(6):51827. doi:10.1016/j.jcin.2018.12.011.
23. Saw J, Humphries K, Aymong E, et al. Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence. J Am Coll Cardiol. 2017;70(9):1148-58. doi:10.1016/j.jacc.2017.06.053.
24. Saw J. Coronary angiogram classification of spontaneous coronary artery dissection. Catheter Cardiovasc Interv. 2014;84(7):1115-22. doi:10.1002/ccd.25293.
25. Saw J, Mancini GB, Humphries K, et al. Angiographic appearance of spontaneous coronary artery dissection with intramural hematoma proven on intracoronary imaging. Catheter Cardiovasc Interv. 2016;87(2):E54-61. doi:10.1002/ccd.26022.
26. Leipsic J, Abbara S, Achenbach S, et al. SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 2014;8(5):342-58. doi:10.1016/j.jcct.2014.07.003.
27. Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52(21):1724-32. doi:10.1016/j.jacc.2008.07.031.
28. Eleid MF, Tweet MS, Young PM, et al. Spontaneous coronary artery dissection: challenges of coronary computed tomography angiography. Eur Heart J Acute Cardiovasc Care. 2018;7(7):60913. doi:10.1177/2048872616687098.
29. Torres-Ayala SC, Maldonado J, Bolton JS, et al. Coronary computed tomography angiography of spontaneous coronary artery dissection: a case report and review of the literature. Am J Case Rep. 2015;16:130-5. doi:10.12659/ajcr.892805.
30. Alzand BSN, Vanneste L, Fonck D, et al. Spontaneous coronary artery dissection undissolved using cardiac computed tomography. Int J Cardiol. 2016;222:1040-1. doi:10.1016/j.ijcard.2016.08.058.
31. Tweet MS, Akhtar NJ, Hayes SN, et al. Spontaneous coronary artery dissection: Acute findings on coronary computed tomography angiography. Eur Heart J Acute Cardiovasc Care. 2019;8(5):467-475. doi.org/10.1177/2048872617753799.
32. Rogowski S, Maeder MT, Weilenmann D, et al. Spontaneous Coronary Artery Dissection: Angiographic Follow-Up and LongTerm Clinical Outcome in a Predominantly Medically Treated Population. Catheter Cardiovasc Interv. 2017;89(1):59-68. doi:10.1002/ccd.26383.
33. Tweet MS, Eleid MF, Best PJ, et al. Spontaneous coronary artery dissection: revascularization versus conservative therapy. Circ Cardiovasc Interv. 2014;7(6):777-86. doi:10.1161/circinterventions.114.001659.
34. Macaya F, Salinas P, Gonzalo N, et al. Spontaneous coronary artery dissection: contemporary aspects of diagnosis and patient management. Open Heart. 2018;5(2):e000884. doi:10.1136/openhrt-2018-000884.
35. Alfonso F, Paulo M, Dutary J. Endovascular imaging of angiographically invisible spontaneous coronary artery dissection. JACC Cardiovasc Interv. 2012;5(4):452-3. doi:10.1016/j.jcin.2012.01.016.
36. Saw J, Mancini GBJ, Humphries KH. Contemporary Review on Spontaneous Coronary Artery Dissection. J Am Coll Cardiol. 2016;68(3):297-312. doi:10.1016/j.jacc.2016.05.034.
37. Eleid MF, Guddeti RR, Tweet MS, et al. Coronary artery tortuosity in spontaneous coronary artery dissection: angiographic characteristics and clinical implications. Circ Cardiovasc Interv. 2014;7(5):656-62. doi:10.1161/circinterventions.114.001676.
38. García-Guimaraes M, Bastante T, Macaya F, et al. Spontaneous coronary artery dissection in Spain: clinical and angiographic characteristics, management, and in-hospital events. Rev Esp Cardiol (Engl Ed). 2021;74(1):15-23. English, Spanish. doi:10.1016/j.rec.2020.04.002.
39. Арефьев М.Н., Клыков Л.Л., Крылов В.В. и др. Инфаркт миокарда и проблема индивидуализации лечения. Клинический пример спонтанной диссекции двух коронарных артерий. Кардиоваскулярная терапия и профилактика. 2017;16(4):8892. doi:10.15829/1728-8800-2017-4-88-92.
40. Vrints CJ. Spontaneous coronary artery dissection. Heart. 2010;96(10):801-8. doi:10.1136/hrt.2008.162073.
41. Cerrato E, Giacobbe F, Quadri G, et al. DISCO Collaborators. Antiplatelet therapy in patients with conservatively managed spontaneous coronary artery dissection from the multicentre DISCO registry. Eur Heart J. 2021;42(33):3161-71. doi:10.1093/eurheartj/ehab372.
42. Lempereur M, Fung A, Saw J. Stent mal-apposition with resorption of intramural hematoma with spontaneous coronary artery dissection. Cardiovasc Diagn Ther. 2015;5(4):323-9. doi:10.3978%2Fj.issn.2223-3652.2015.04.05.
43. Watt J, Egred M, Khurana A, et al. 1-Year Follow-Up Optical Frequency Domain Imaging of Multiple Bioresorbable Vascular Scaffolds for the Treatment of Spontaneous Coronary Artery Dissection. JACC Cardiovasc Interv. 2016;9(4):389-91. doi:10.1016/j.jcin.2015.11.030.
44. Panoulas VF, Ielasi A. Bioresorbable scaffolds and drug-eluting balloons for the management of spontaneous coronary artery dissections. J Thorac Dis. 2016;8(10):E1328-30. doi:10.21037/jtd.2016.10.54.
45. Camacho Freire SJ, Gómez Menchero AE, Roa Garrido J, et al. Bioresorbable Scaffolds in Spontaneous Coronary Artery Dissection: Long-Term Follow-Up in 4 Patients. Tex Heart Inst J. 2017;44(6):405-10. doi:10.14503%2FTHIJ-16-6059.
46. Macaya F, Salinas P, Gonzalo N, et al. Long-term followup of spontaneous coronary artery dissection treated with bioresorbable scaffolds. EuroIntervention. 2019;14(13):1403-5. doi:10.4244/eij-d-18-00519.
47. Прохорихин А. А., Фартаков Е. И., Малаев Д. У. и др. Оценка эффективности и безопасности биодеградируемого каркаса Absorb: 6-месячные результаты регистра Gabi R: Russia. Патология кровообращения и кардиохирургия. 2019;23(1S):S26-33. doi:10.21688/1681-3472-2019-1S-S26-S33.
48. Main A, Lombardi WL, Saw J. Cutting balloon angioplasty for treatment of spontaneous coronary artery dissection: case report, literature review, and recommended technical approaches. Cardiovasc Diagn Ther. 2019;9(1):50-4. doi:10.21037/cdt.2018.10.11.
49. Kaya E, Iwata H, Miyazaki S, et al. Successful Coronary Flow Restoration by Stent-Free Strategy Using the Pull-Back Method of Cutting Balloon in Spontaneous Coronary Artery Dissection. CJC Open. 2019;1(4):213-5. doi:10.1016%2Fj.cjco.2019.05.008.
50. Жукова Н. С., Шахнович Р. М., Меркулова И. Н. и др. Спонтанная диссекция коронарных артерий. Кардиология. 2019;59(9):52-63. doi:10.18087/cardio.2019.9.10269.