以不典型胸痛为首发症状的主动脉夹层误诊为急性冠脉综合征临床分析OA

Objective To analyze the causes of aortic dissection with atypical chest pain as the initial symptom misdiagnosed as acute coronary syndrome(ACS).Methods A retrospective analysis was conducted on the clinical data of 2 patients with aortic dissection who were misdiagnosed as ACS from January 2022 to January 2024.Results One patient presented with sudden onset of crushing retrosternal pain for 2 h.The electrocardiogram showed ST segment elevation of 0.2-0.3 mV in leads V1 to V4,and troponin I was 1.5 ng/mL.The preliminary diagnosis was acute anterior ST segment elevation myocardial infarction.Emergency coronary angiography revealed 50％stenosis in the middle segment of the left anterior descending artery,but during the operation,the ascending aorta was found to be dilated with contrast agent retention.Further aortic CT angiography(CTA)confirmed Stanford type A aortic dissection,with a misdiagnosis duration of 12 h.Aortic ascending artery replacement+full arch replacement+Frozen Elephant Trunk procedure was performed.The patient recovered well after the operation,and there were no complications or new aortic dissection during the 6-month follow-up.Another case presented with intermittent chest pain accompanied by cold sweats for 3 d.The electrocardiogram showed ST segment depression of 0.1 mV in leads Ⅱ,Ⅲ,and aVF,and troponin T was 0.8 ng/mL.The diagnosis was non-ST segment elevation myocardial infarction.Coronary angiography showed 30％stenosis at the proximal right coronary artery,but a dissection flap shadow was detected in the aortic root.Emergency aortic CTA confirmed Stanford type B aortic dissection,with a misdiagnosis duration of 48 h.After consultation with Department of Vascular Medicine,a thoracic endovascular aortic repair was performed.The chest pain disappeared after the operation,and the patient recovered well at 12-month follow-up.Conclusion In patients with aortic dissection,coronary angiography may present with non-obstructive lesions accompanied by abnormal aortic morphology.When coronary lesions cannot account for the severe clinical symptoms,the possibility of aortic dissection should be suspected,and timely aortic imaging examination is the key to avoiding misdiagnosis.