BACKGROUND Spontaneous coronary artery dissection (SCAD) has emerged as an important etiology of myocardial infarction and sudden death, especially in young women. Early diagnosis is essential for appropriate management. OBJECTIVES To explore the value of plasma fibrillin-1 (FBN1) levels in patients with SCAD. METHODS 70 patients with non-atherosclerotic SCAD between January 2014 and September 2018 were age and sex matched with 70 patients with non-SCAD acute coronary syndrome (ACS) and 70 healthy controls. The plasma FBN1 level was measured and compared among three groups. The value of FBN1 for prognosis and treatment decision making was further explored. RESULTS The plasma FBN1 level of SCAD group (58.44 ± 7.06 ng/mL) was higher than that of non-SCAD ACS group (52.39 ± 6.92 ng/mL, P < 0.001) or healthy controls (50.56 ± 4.48 ng/mL, P < 0.001). Compared with controls, significantly higher percentages of patients with SCAD were found in the highest compared with lowest quartile of FBN1 concentration. The area under the curve (AUC) for plasma FBN1 level to discriminate patients with SCAD from non-SCAD ACS was 0.81 (95% CI 0.74-0.88, P < 0.001). A cut-off value of 54.64 ng/mL was determined to differentiate SCAD from non-SCAD ACS with a sensitivity of 0.77 (95%CI: 0.66-0.86) and specificity of 0.76 (95%CI: 0.64-0.85). After a median follow-up of 28.35 (14.07 ± 44.69) months, 11 (15.7%) cases suffered from major adverse cardiac events (MACE). Higher FBN1 level was detected in patients with MACE (63.71 ± 7.49 vs. 57.45 ± 6.58 ng/mL) (P = 0.006). A cut-point of 58.14 was determined for SCAD patients to identify MACE. At this point, FBN1 might also have potential use for decision making in SCAD patients. CONCLUSION Plasma FBN1 is a promising biomarker for aiding the diagnosis of SCAD and have potential value in prognosis prediction.

中文翻译：

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自发性冠状动脉夹层患者血浆原纤维蛋白-1水平的价值。

背景技术自发性冠状动脉夹层术（SCAD）已经成为心肌梗塞和猝死的重要病因，特别是在年轻女性中。早期诊断对于适当的管理至关重要。目的探讨血浆原纤维蛋白-1（FBN1）在SCAD患者中的价值。方法2014年1月至2018年9月期间70例非动脉粥样硬化SCAD患者的年龄和性别与70例非SCAD急性冠脉综合征（ACS）患者和70例健康对照患者年龄和性别相匹配。测量血浆中FBN1水平，并在三组中进行比较。FBN1在预后和治疗决策中的价值得到了进一步的探索。结果SCAD组血浆FBN1水平（58.44±7.06 ng / mL）高于非SCAD ACS组（52.39±6.92 ng / mL，P <0.001）或健康对照组（50.56±4.48 ng / mL，P < 0.001）。与对照组相比，FBN1浓度的最高四分位数与最低四分位数相比较，发现SCAD患者的百分比明显更高。血浆FBN1水平在曲线下的面积（AUC）区分SCAD患者与非SCAD ACS患者为0.81（95％CI 0.74-0.88，P <0.001）。测定的临界值为54.64 ng / mL，以区分SCAD和非SCAD ACS，灵敏度为0.77（95％CI：0.66-0.86），特异性为0.76（95％CI：0.64-0.85）。在中位随访28.35（14.07±44.69）个月后，有11例（15.7％）患了严重的心脏不良事件（MACE）。在MACE患者中检测到较高的FBN1水平（63.71±7.49 vs. 57.45±6.58 ng / mL）（P = 0.006）。确定SCAD患者可以识别出MACE的临界点为58.14。在此刻，FBN1也可能在SCAD患者的决策中具有潜在用途。结论血浆FBN1是一种有前途的生物标志物，有助于SCAD的诊断，在预测预后方面具有潜在的价值。