Data_Sheet_1_Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health System.docx

BackgroundCoronary revascularization in patients with spontaneous coronary artery dissection (SCAD) is challenging. Indications and results of percutaneous coronary interventions (PCI) in SCAD patients are not well established.
AimTo assess indications and results of PCI in SCAD.
MethodsThe minimum basic data set of the Spanish National Health System (years 2016−2019) was used to identify 804 episodes of acute myocardial infarction (AMI) and SCAD, with a crude in-hospital mortality rate of 3%. Of these, 368 (46.8%) patients were revascularized with PCI during admission whereas 436 (54.2%) were managed conservatively.
ResultsRevascularization and in-hospital mortality rates both declined over the study period (p for trend both < 0.05). SCAD patients treated with PCI were older, more frequently male, and had higher frequency of diabetes, ST-segment elevation AMI and cardiogenic shock, compared to patients managed conservatively. The crude in-hospital mortality rate was higher in patients treated with PCI (4.9% vs. 1.4%; p = 0.004). However, after adjusting by propensity score (223 pairs) the in-hospital mortality rate was similar in the two groups (Adj OR: 1.21; 95%CI: 0.30−1.57; p = 0.76). Readmissions at 30-days were higher in patients managed conservatively (7.1 vs. 1.6%, p < 0.001) and this difference was maintained after propensity score adjustment (Adj average treatment effect: 2% vs. 12.2%; OR: 0.15; 95%CI: 0.04−0.45; p < 0.001).
ConclusionRevascularization is frequently used in unselected patients with AMI and SCAD but its use is declining. Patients with SCAD treated with PCI have a higher in-hospital mortality but this appears to be explained by their adverse baseline clinical characteristics.

背景 自发性冠状动脉夹层（Spontaneous Coronary Artery Dissection, SCAD）患者的冠状动脉血运重建治疗颇具挑战性。目前，SCAD患者行经皮冠状动脉介入治疗（Percutaneous Coronary Interventions, PCI）的适应证与临床结局尚未明确。
目的 评估SCAD患者行PCI的适应证与临床结局。
方法 本研究采用西班牙国家卫生系统2016-2019年的最小基础数据集，共筛选出804例合并SCAD的急性心肌梗死（Acute Myocardial Infarction, AMI）患者，其粗住院死亡率为3%。其中368例（46.8%）患者在住院期间接受PCI血运重建治疗，剩余436例（54.2%）患者采取保守治疗策略。
结果 研究期间，血运重建率与住院死亡率均呈下降趋势（趋势检验p值均<0.05）。与保守治疗组相比，PCI治疗组的SCAD患者年龄更大、男性占比更高，且糖尿病、ST段抬高型AMI及心源性休克的发生率也更高。PCI治疗组的粗住院死亡率显著高于保守治疗组（4.9% vs. 1.4%；p=0.004）。但经倾向得分匹配校正后（共223对匹配样本），两组的住院死亡率无显著差异（校正后比值比[Adj OR]：1.21；95%置信区间[95%CI]：0.30~1.57；p=0.76）。保守治疗组的30天再入院率更高（7.1% vs. 1.6%，p<0.001），且该差异在倾向得分匹配校正后依然存在（校正后平均治疗效应：2% vs. 12.2%；OR：0.15；95%置信区间[95%CI]：0.04~0.45；p<0.001）。
结论 针对未经过筛选的合并SCAD的AMI患者，血运重建治疗应用较为普遍，但该治疗方式的使用率呈下降趋势。接受PCI治疗的SCAD患者住院死亡率更高，但这一差异可通过其不良的基线临床特征得到解释。