Author + information
- Chayakrit Krittanawong, MD∗ ( and )
- Bing Yue, MD
- ↵∗Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, 1000 10th Avenue, Suite 3A-09, New York, New York 10019
In a Mayo Clinic spontaneous coronary artery dissection (SCAD) registry, Tweet et al. (1) retrospectively reviewed 323 women with SCAD and 54 women who met criteria for pregnancy-associated SCAD (P-SCAD). They concluded that patients with P-SCAD had more high-risk features (left main coronary artery or multivessel disease and myocardial dysfunction) and were less likely to have extracoronary vascular abnormalities than were nonpregnant patients with SCAD. We thank Tweet et al. (1) for emphasizing P-SCAD and its high-risk features because a lack of awareness of a P-SCAD diagnosis could potentially lead to severe or fatal complications.
In this large, nationwide analysis of pregnancy-related SCAD hospitalizations, we describe contemporary trends in potentially miscoding SCAD-related pregnancy or P-SCAD. The Agency for Healthcare Research and Quality created the Nationwide Inpatient Sample, which includes discharge data from >1,200 hospitals. Each entry comprises hospitalization for a single patient and is associated with a primary discharge diagnosis and up to 24 secondary diagnoses. Multiple prior studies have used the Nationwide Inpatient Sample to study various conditions (2,3). We extracted data for this retrospective cohort study from the Nationwide Inpatient Sample for 2014 by using the International Classification of Diseases-9th Revision (ICD-9) code 414.12 (SCAD). Pregnancy-related discharges were also identified using the ICD-9 (codes 630 to 648, 650 to 659) or the ICD-9 codes for postpartum admission (codes 670 to 677). All analyses were conducted using R 3.4.0 (R Foundation, Vienna, Austria) and Stata/MP 14.2 software (Stata Corp., College Station, Texas). All p values were 2-sided, and statistical significance was determined at the level of p < 0.05.
A total of 270 patients with SCAD were identified. Patients were predominantly women (71%), and the mean age was 53 years. The overall in-hospital mortality rate was 5.6%, with a 6.6% rate in males and a 5.3% rate in females. Interestingly, of those patients with SCAD, no pregnancy-related admissions were identified. In a Mayo Clinic SCAD registry, cardiovascular imaging (i.e., angiography, intravascular ultrasound, and optical coherence tomography) was reviewed by interventional cardiologists in all patients with SCAD. Therefore, Tweet et al. (1) were likely to identify P-SCAD in the registry. In contrast, our results showed that no pregnancy-related admissions identified patients with SCAD in a nationwide analysis. In fact, the diagnoses of SCAD, pregnancy, and its complications in a large, nationwide study were coded by ICD-9. This could potentially lead to the misdiagnosis of P-SCAD, which is associated with more high-risk features than in non-pregnant patients with SCAD.
In conclusion, this preliminary nationwide analysis may shed light on the difficulty in identifying patients with P-SCAD in pregnancy-related hospitalizations.
Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation
- Tweet M.S.,
- Hayes S.N.,
- Codsi E.,
- Gulati R.,
- Rose C.H.,
- Best P.J.M.
- James A.H.,
- Jamison M.G.,
- Biswas M.S.,
- Brancazio L.R.,
- Swamy G.K.,
- Myers E.R.