Pregnancy-Associated Spontaneous Coronary Artery Dissection: Clinical Characteristics, Outcomes, and Risk During...

Area of Science:

• Cardiology
• Obstetrics
• Vascular Medicine

Background:

• Spontaneous coronary artery dissection (SCAD) is a significant cause of myocardial infarction, particularly in pregnant individuals.
• Pregnancy-associated SCAD (P-SCAD) requires careful comparison with non-pregnancy SCAD (NP-SCAD) to understand distinct clinical trajectories and outcomes.

Purpose of the Study:

• To compare the clinical presentation, management, and longitudinal follow-up of P-SCAD cases with NP-SCAD cases.
• To evaluate the risks associated with subsequent pregnancies in women with a history of SCAD.

Main Methods:

• Retrospective analysis of 22 P-SCAD cases and 285 NP-SCAD cases from Kaiser Permanente Northern California (September 2002 - June 2017).
• Comparison of demographic data, clinical characteristics, treatment strategies, and cardiovascular outcomes between the two groups.

Main Results:

• P-SCAD patients were younger, had higher multigravidity, and a greater proportion were of advanced maternal age.
• P-SCAD was associated with more proximal and multiple vessel dissections, reduced ejection fraction at presentation, and higher rates of cardiogenic shock or need for intra-aortic balloon pump support.
• Despite a higher incidence of major adverse cardiovascular events during the acute phase, P-SCAD patients showed similar long-term prognosis regarding recurrent SCAD and cardiovascular death compared to NP-SCAD. Seven patients had successful subsequent pregnancies.

Conclusions:

• P-SCAD is characterized by a higher-risk presentation but shares a similar long-term prognosis with NP-SCAD.
• Subsequent pregnancy following SCAD can be undertaken with acceptable risk, with seven reported successful pregnancies without cardiac complications.