Spontaneous Coronary Artery Dissection Associated With Pregnancy

Area of Science:

• Cardiology
• Obstetrics
• Vascular Medicine

Background:

• Spontaneous coronary artery dissection (SCAD) is a leading cause of myocardial infarction during pregnancy, yet it is poorly understood.
• Pregnancy-associated SCAD (P-SCAD) requires further characterization to understand its unique clinical profile and outcomes.

Purpose of the Study:

• To compare the clinical presentation, risk factors, and outcomes of P-SCAD with SCAD unrelated to pregnancy (NP-SCAD).
• To identify specific characteristics and potential contributing factors associated with P-SCAD.

Main Methods:

• A retrospective and prospective registry of SCAD data was utilized, established in 2010 at Mayo Clinic.
• Records of 323 women with SCAD were reviewed, identifying 54 cases of P-SCAD (including 4 during pregnancy) and comparing them with 269 cases of NP-SCAD.
• Data analysis focused on presentation, clinical factors, vascular imaging, pregnancy history, and long-term recurrence rates.

Main Results:

• P-SCAD patients more frequently experienced ST-segment elevation myocardial infarction, left main or multivessel SCAD, and reduced left ventricular function compared to NP-SCAD.
• The majority of P-SCAD events (35/50) occurred within the first month postpartum.
• P-SCAD was less frequently associated with fibromuscular dysplasia and extracoronary vascular abnormalities; however, P-SCAD patients were more likely to be multiparous, have a history of infertility treatments, and experience pre-eclampsia.

Conclusions:

• Pregnancy-associated SCAD (P-SCAD) presents with more acute and high-risk features compared to NP-SCAD.
• The postpartum period, particularly the first month, represents the highest risk for P-SCAD, which is less commonly linked to extracoronary vascular abnormalities.
• Hormonal and hemodynamic changes during pregnancy and postpartum, alongside other undefined mechanisms, are likely significant contributors to P-SCAD.