Author + information
- Marysia S. Tweet,
- Sharonne Hayes,
- Elisabeth Codsi,
- Rajiv Gulati,
- Carl H. Rose and
- Patricia Best
Background: Spontaneous coronary artery dissection (SCAD) is the most common cause of pregnancy-associated myocardial infarction and remains incompletely characterized to date.
Methods: Records of all women enrolled in the Mayo Clinic “Virtual” Multi-Center SCAD Registry were reviewed to identify those who were pregnant or ≤12 weeks postpartum at time of SCAD (P-SCAD). Presentation, clinical factors including fibromuscular dysplasia (FMD), pregnancy outcomes, and recurrent SCAD were assessed. Patients with P-SCAD were compared to those with SCAD not associated with pregnancy (NP-SCAD).
Results: Of 482 women with history of SCAD, 54 met criteria for P-SCAD, with 4 events occurring during the antepartum interval. They were compared to 269 women with NP-SCAD. Mean age of P-SCAD was 35+4 (26-42) years, and all pregnancies except two resulted in a live birth. Most SCAD events occurred within the first 30 days postpartum (26/50, 72%). Compared to those women with NP-SCAD, P-SCAD patients more frequently presented with STEMI (50% vs 36%, p=0.013), left main and multivessel SCAD (24% vs. 5%, p<0.0001 and 33% vs 14%, p=0.001, respectively) and with lower left ventricular function on presentation (p<0.0005). While P-SCAD patients were more likely to have history of fertility treatments and multiple pregnancies than NP-SCAD (28% vs 16%, p=0.047; 91% vs 76%, p=0.014), they were less likely to have a diagnosis of FMD following dedicated imaging (40% vs 65%, p=0.02). On long-term follow-up (median 1.6 years, Q1-Q3 0.7-3.9), recurrent SCAD occurred in a total of 52 patients with no difference between the SCAD groups (8/54 vs 44/269, p=0.79).
Conclusions: The highest frequency of P-SCAD occurred during the first postpartum month. P-SCAD patients have more severe presentation and high risk features than women with NP-SCAD. Compared to women with NP-SCAD, P-SCAD patients were more likely to have history of fertility treatments and multiple pregnancies, but not FMD, suggesting that hormonal and hemodynamic variations may be primary contributors to P-SCAD.
Moderated Poster Contributions
Interventional Cardiology Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 10:00 a.m.-10:10 a.m.
Session Title: PCI Strategies and Outcomes Unique to Women
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1214M-05
- 2017 American College of Cardiology Foundation