Pregnancy-Associated Spontaneous Coronary Artery Dissection
What characteristics are unique to pregnancy-associated spontaneous coronary artery dissection (SCAD)?
Records from the Mayo Clinic registry were reviewed. Women who were pregnant or ≤12 weeks postpartum at the time of SCAD were compared to patients with SCAD not related to pregnancy.
Of 323 patients with SCAD, 54 were pregnancy-associated, and 269 were not. Women with pregnancy-associated SCAD were more likely to present with ST-segment elevation myocardial infarction (STEMI) (57% vs. 36%, p = 0.009), have left main (24% vs. 5%, p < 0.0001) or multivessel (33% vs. 14%, p = 0.003) SCAD, and have ejection fraction ≤35% (26% vs. 10%, p = 0.007). They were less likely to have a diagnosis of fibromuscular dysplasia than those with nonpregnancy-associated SCAD (42% vs. 64%, p = 0.047). Patients with pregnancy-associated SCAD most commonly presented in the first month, often the first week after delivery. Recurrence rates were similar (10% vs. 23%, p = nonsignificant) between patients with/without pregnancy-associated SCAD.
Pregnancy-associated SCAD patients typically presented in the first month postpartum, had more high-risk features (left main or multivessel disease and myocardial dysfunction), and were less likely to have extracoronary vascular abnormalities than nonpregnant patients with SCAD.
This paper demonstrates that women who present with SCAD related to pregnancy often present early (within the first week or month postpartum) and can have severe presentations. Clinicians should have a high index of suspicion for SCAD among pregnant and early postpartum women presenting with chest pain. Much more research about SCAD is needed. Factors influencing pregnancy-associated SCAD remain unknown. A portion of women with pregnancy-associated SCAD were found to have a diagnosis of fibromuscular dysplasia, but many do not have extracoronary abnormalities. Hormonal, vascular, and hemodynamic changes of pregnancy may play a role. The influence of lactation is unknown. Recurrence rates among women with pregnancy-associated SCAD (10%) did not differ significantly from nonpregnancy-associated SCAD (23%). Predictors of recurrence are unknown. Only a small number of women with a history of SCAD have undergone subsequent pregnancy, and additional research is needed about this subset of women.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Prevention, Vascular Medicine, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias
Keywords: Acute Coronary Syndrome, Chest Pain, Coronary Vessel Anomalies, Dissection, Fibromuscular Dysplasia, Hemodynamics, Myocardial Infarction, Postpartum Period, Pregnant Women, Secondary Prevention, Stroke Volume, Vascular Diseases
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