Objectives. To compare outcomes of percutaneous coronary intervention (PCI) in spontaneous coronary artery dissection (SCAD) patients versus conservative therapy. Background. SCAD is an important cause of myocardial infarction (MI) in young-to-middle-aged women. Percutaneous coronary intervention (PCI) is often pursued, but outcomes compared to conservative therapy are unclear. Methods. 403 nonatherosclerotic SCAD patients were enrolled between 2011 and 2017 and prospectively followed up in our Vancouver General Hospital registries. Detailed baseline, hospital, PCI, and outcomes were recorded. We explored the outcomes of SCAD patients who underwent PCI during their initial presentation. Results. PCI was performed in 75 patients, the average age was 48.9 ± 10.1 yrs, and 94.7% were women. All presented with MI; 50.7% STEMI, 49.3% NSTEMI, and 13.3% had VT/VF. PCI was successful in 34.7%, partially successful in 37.3%, and unsuccessful in 28.0%. Stents were deployed in 73.3%, 16.0% had balloon angioplasty alone, 10.7% had wiring attempts only, and 5.3% required bailout surgery. Major adverse cardiovascular event rates (MACE) were significantly higher with the PCI group in hospital (29.3% versus 2.8%, ), and at median follow-up of 3.7 yrs (58.7% versus 22.6% () compared to the non-PCI group. Conclusion. PCI in SCAD patients was associated with high failure rate and MACE in hospital and at long-term follow-up. These findings support the recommendation of conservative therapy as first-line management unless high-risk features are present.

中文翻译：

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自发性冠状动脉夹层患者经皮冠状动脉介入治疗的结果

目标。为了比较自发性冠状动脉夹层（SCAD）患者与保守治疗的经皮冠状动脉介入治疗（PCI）的结果。背景。SCAD是年轻至中年妇女心肌梗死（MI）的重要原因。经常采用经皮冠状动脉介入治疗（PCI），但与保守治疗相比结果尚不清楚。方法。在2011年至2017年之间招募了403名非动脉粥样硬化SCAD患者，并在我们的温哥华总医院注册表中进行了随访。记录详细的基线，医院，PCI和结局。我们探讨了在初次就诊期间接受PCI的SCAD患者的结局。结果。75例患者接受了PCI，平均年龄为48.9±10.1岁，女性为94.7％。与MI一起呈现；VT / VF占50.7％STEMI，49.3％NSTEMI和13.3％。PCI成功率为34.7％，部分成功率为37.3％，未成功为28.0％。支架的部署率为73.3％，仅球囊血管成形术的占16.0％，仅尝试布线的占10.7％，需要救助手术的占5.3％。住院PCI组的主要不良心血管事件发生率（MACE）显着更高（29.3％对2.8％，），中位随访时间为3.7年（分别为58.7％和22.6％（）与非PCI组进行比较。结论。SCAD患者的PCI与高失败率和住院及长期随访中的MACE有关。这些发现支持推荐保守治疗作为一线治疗，除非存在高风险特征。