Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients

• Published in: European heart journal cardiovascular imaging Vol. 18; no. 1; pp. 54 - 61
• Main Authors: Cade, Jamil R., Szarf, Gilberto, de Siqueira, Maria Eduarda M., Chaves, Áurea, Andréa, Júlio C. M., Figueira, Hélio R., Gomes, Manuel M., Freitas, Bárbara P., Filgueiras Medeiros, Juliana, dos Santos, Márcio Ricardo, Fiorotto, Walter B., Daige, Augusto, Gonçalves, Rosaly, Cantarelli, Marcelo, Alves, Cláudia Maria Rodrigues, Echenique, Leandro, de Brito, Fábio S., Perin, Marco A., Born, Daniel, Hecht, Harvey, Caixeta, Adriano
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-01-2017
• Subjects: Adult; Computed Tomography Angiography - methods; Coronary Angiography - methods; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessel Anomalies - mortality; Coronary Vessel Anomalies - therapy; Databases, Factual; Female; Follow-Up Studies; Gestational Age; Hospital Mortality; Humans; Multimodal Imaging - methods; Percutaneous Coronary Intervention - methods; Percutaneous Coronary Intervention - mortality; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular - diagnostic imaging; Pregnancy Complications, Cardiovascular - therapy; Pregnancy Outcome; Retrospective Studies; Risk Assessment; Sampling Studies; Tertiary Care Centers; Ultrasonography, Interventional - methods; Vascular Diseases - congenital; Vascular Diseases - diagnostic imaging; Vascular Diseases - mortality; Vascular Diseases - therapy; intravascular ultrasound; optical coherence tomography; spontaneous coronary artery dissection; acute myocardial infarction; peripartum
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jew021

Aims We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes.
Methods and results Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient.
Conclusion In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.