Spontaneous Exercise-Related Coronary Artery Dissection among Young Patients Without Risk Factors or Atherosclerotic Disease

Abstract Spontaneous coronary artery dissection (SCAD) is considered an often underdiagnosed acute coronary syndrome, with few cases described in literature. Its association with physical exercise among young patients without risk factors or atherosclerotic disease (CAD) is even rarer. For this reason, a study was conducted on the subject, describing the clinical conditions, conduct and evolution regarding the suspicion of spontaneous exercise-related coronary artery dissection in three young patients without risk factors or CAD. Clinical conditions varied, with predominant recurrent chest pain. Age range from 20 to 31 years. All patients underwent coronary angiography, which showed no CAD but suggested SCAD. Investigations concerning other causes of coronary obstruction were negative. The right coronary artery was affected in two cases, and the anterior descending artery was affected in one case. Only one of the three patients had recurrent events within five years from the primary event. Technological advances will enable increased dissection identification in acute coronary syndromes. Improving the knowledge about the related clinical conditions is necessary, as an attempt to provide warnings and improve the suspicion of spontaneous exercise-related coronary artery dissection among those who have symptoms of coronary insufficiency, thus reducing the frequent underdiagnosis. The best treatment and prognosis for this disease remains uncertain.

摘要 自发性冠状动脉夹层（Spontaneous Coronary Artery Dissection, SCAD）被认为是一类常被漏诊的急性冠状动脉综合征，相关文献报道的病例较少。在无危险因素或冠状动脉粥样硬化性心脏病（Coronary Atherosclerotic Disease, CAD）的年轻患者中，该病与体育锻炼的关联更为罕见。为此，本研究针对该主题展开，报道了3例无危险因素或冠状动脉粥样硬化性心脏病的年轻患者疑似运动相关性自发性冠状动脉夹层的临床情况、诊疗经过及转归。患者临床表现各异，以反复发作性胸痛为主要表现，年龄介于20至31岁之间。所有患者均接受了冠状动脉造影检查，结果未提示冠状动脉粥样硬化性心脏病，但疑似自发性冠状动脉夹层。针对冠状动脉梗阻其他病因的相关检查结果均为阴性。2例受累血管为右冠状动脉，1例为前降支。3例患者中仅1例在首发事件发生后5年内出现复发事件。技术进步将有助于提高急性冠状动脉综合征患者夹层的检出率。有必要加深对该病相关临床特征的认识，以期为冠心病症状患者提供预警，并提高对运动相关性自发性冠状动脉夹层的疑似诊断率，从而降低频繁发生的漏诊率。目前该病的最佳治疗方案与预后仍未明确。