种族差异对自发性冠状动脉夹层表现与结局的影响：澳新注册研究
该前瞻性与回顾性队列研究纳入澳新23家医院622例经核心实验室确认的自发性冠状动脉夹层（SCAD）患者，按四个种族分组分析。结果显示中东、北非、非洲裔患者妊娠相关SCAD比例更高且胸痛比例更低，原住民与太平洋岛民旁观者动脉粥样硬化比例更高，亚裔心外血管异常比例更高；校正混杂因素后种族非MACE独立预测因素，各组无MACE生存率相似。
要点
- SCAD患者以白人为主（78.5%），但不同种族在临床表现和血管特征上存在差异。
- 中东、北非、非洲裔患者妊娠相关SCAD比例更高（24% vs 总体2%）。
- 原住民与太平洋岛民旁观者动脉粥样硬化比例更高（25% vs 总体16%）。
核心结论
- 本研究首次描述澳新SCAD注册中患者的种族分布，发现不同种族在妊娠相关SCAD和旁观者动脉粥样硬化等方面存在重要差异。
- 校正潜在混杂因素后，种族并非MACE的独立预测因素，各组无MACE生存率相似。
研究设计与样本
- 前瞻性与回顾性队列研究，招募自澳大利亚和新西兰23家医院的成年ACS且经核心实验室确认SCAD的患者。
- 共纳入622例SCAD患者，按澳大利亚统计局和新西兰统计局种族标准分为白人、亚裔、中东/北非/非洲裔（MENAA）、原住民与太平洋岛民四组。
- 采用Cox比例风险模型分析MACE预测因素。
主要发现
- 622例SCAD患者中，白人488例（78.5%），亚裔45例（7.2%），MENAA 29例（4.7%），原住民与太平洋岛民48例（7.7%），其他12例（1.9%）。
- 分析队列平均年龄52.3±10.5岁，女性占87.9%。
- MENAA患者妊娠相关SCAD发生率更高（24% vs 总体2%，p<0.001），胸痛发生率更低（86% vs 总体96%，p=0.008）。
- 原住民与太平洋岛民旁观者动脉粥样硬化发生率更高（25% vs 总体16%，p=0.02）。
- 亚裔患者非纤维肌性发育不良性心外血管异常发生率更高（16% vs 总体5%，p=0.008）。
临床怎么用
- 临床遇SCAD患者时应关注种族背景，MENAA患者需警惕妊娠相关SCAD，原住民与太平洋岛民患者需评估旁观者动脉粥样硬化。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an uncommon but increasingly recognised, important cause of acute coronary syndrome (ACS) primarily described in European and North American populations, with ethnic differences poorly understood. We investigated the ethnic distribution of patients with SCAD and ethnic differences in major adverse cardiovascular events (MACEs). METHODS: This prospective and retrospective cohort study recruited adult patients with ACS and core-laboratory confirmed SCAD from 23 hospitals in Australia and New Zealand. Patients were analysed in four ethnic groups following the Australian Bureau of Statistics and Statistics New Zealand Standards for Ethnicity: white; Asian; Middle Eastern, North African, African (MENAA); and First Nations and Pacific Peoples. Predictors of MACEs were investigated with Cox proportional hazards models. RESULTS: Of 622 patients with SCAD, 488 (78.5%) were white, 45 (7.2%) Asian, 29 (4.7%) MENAA, 48 (7.7%) First Nations and Pacific Peoples and 12 (1.9%) Other. Of the analysed cohort (mean age 52.3±10.5 years, 87.9% female), MENAA patients had higher rates of pregnancy-associated SCAD (24% vs 2% overall, p<0.001) and lower chest pain rates (86% vs 96% overall, p=0.008). First Nations and Pacific Peoples had higher rates of bystander atherosclerosis (25% vs 16% overall, p=0.02). Asian patients had higher rates of non-fibromuscular dysplasia extracardiac vascular abnormalities (16% vs 5% overall, p=0.008). MACE-free survival was similar across ethnic groups, and ethnicity was not an independent predictor of MACE when adjusted for potential confounders. CONCLUSIONS: This study is the first to describe the diverse ethnic distribution of patients with SCAD in the Australian-New Zealand-SCAD registry. Important ethnic differences include higher rates of pregnancy-SCAD in MENAA patients, and higher rates of bystander atherosclerosis in First Nations and Pacific Peoples patients. No ethnic difference was seen in MACE-free survival following SCAD.
引用
- Jung, S Haghighi, Dang, et al. Ethnicity and its impact on presentation and outcomes in patients with spontaneous coronary artery dissection from the Australian-New Zealand registry. Heart. 2026. PMID: 42009569. doi:10.1136/heartjnl-2026-327842
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。