Spontana disekcija koronarnih arterija kao uzrok akutnog koronarnog sindroma

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is generally considered a rare event, which can be fatal if not detected and treated in time (0.07 to 1.1% in the general population of patients with acute coronary syndrome). It represents an unusual cause of acute coronary syndrome (ACS), which is not associated with traditional risk factors. Most published cases of SCAD are associated with pregnancy and the existing atherosclerosis, while little is known about any other predisposing factors for the occurrence of this disease. There are many more results in the field of recognition of risk factors associated with the development SCAD than reaching an agreement on the therapeutic approach to this entity in the ACS. Methods: The aim of this study was to investigate the frequency of SDKA as the cause of acute coronary syndrome (ACS) during the four-year follow-up in the room for catheterization Clinic for Cardiovascular Diseases, Clinical Centre Nis, as well as to draw attention to this rare cause of ACS which chiefly occurs in youth population, requires an individual and specific therapeutic approach and secondary prevention. Current published literature data on this subject is also presented. Results: Our results showed that during the period from 01.02.2009 to 30.12.2012 in the department of interventional cardiology, 3530 consecutive coronary angiography in patients with acute coronary syndrome (ACS) were analyzed. Out of these, 1080 patients had a diagnosis of ACS with persistent ST-segment elevation (STEMI) and the 2450 patients had a diagnosis of ACS without persistent ST-segment elevation (NSTEMI). Spontaneous coronary artery dissection as a cause of acute coronary syndrome was detected in 6 cases (0,16%). Conclusion: Method of treatment is determined by the weight and presentation of disease and is supported by the conservative strategy in otherwise stable patients with preserved flow in the affected artery. The challenge will be if chest pain is continued in the absence of ischemia, probably due to the change (active processes) in the blood vessel wall or influence on vascular tone. It is necessary to consider this possibility before joining revascularization in patients who only have symptoms but not signs of ischemia.