By Eric Ramos
CHICAGO -- November 20, 2020 -- Spontaneous coronary artery dissection (SCAD) most commonly presents with ST-elevation myocardial infarction (STEMI) and multivessel involvement within the initial 12 weeks following delivery, according to a study presented at the Virtual 2020 American Heart Association (AHA) Scientific Sessions.
“Spontaneous coronary artery dissection is a rare but life threatening cause of acute coronary syndrome and a common etiology of pregnancy-associated myocardial infarction,” stated Angie S. Lobo, Mayo Clinic, Rochester, Minnesota. “Clinicians need to be familiar with this etiology of pregnancy-associated myocardial infarction to avoid delay in diagnosis and appropriate management.”
For the current study, Dr. Lobo and colleagues analysed data from 128 women who were enrolled in the Mayo Clinic SCAD Registry between 2010 and 2020.
The most common symptom on presentation was chest pain (92%), and 62 (48%) women presented with STEMI and 58 (45%) presented with non-STEMI. Multivessel involvement was observed in 40 (31%) women, left anterior descending artery in 88 (69%) women, and left main in 28 (22%) women.
Pregnancy-associated SCAD occurred during pregnancy in only 7 (5%) women -- 2 in the first trimester and 5 in the third trimester; however, most women experienced SCAD after delivery. Most (72%) of the women presented with SCAD less than 12 weeks after delivery and 33 (27%) presented with SCAD between 12 weeks and 1 year postpartum.
Percutaneous coronary intervention (PCI) was performed in 52 (41%) women, with a success rate of 81%. Coronary artery bypass grafting was performed in 24 (19%) patients (6 from the unsuccessful PCI group).
A total of 84 women were screened for an underlying arteriopathy, and 44 (52 %) were diagnosed with fibromuscular dysplasia.
After a median follow-up time of 3 years 12 (9%) women had a recurrent SCAD event; 7 occurred within 1 year after delivery. Risk factors for SCAD recurrence and effective prevention strategies are unknown and remain a principal concern for patients and clinicians.
There were no deaths.
[Presentation title: Spontaneous Coronary Artery Dissection Associated With Pregnancy. Abstract 708]
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