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BIBTEX RIS

Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients

2016; Oxford University Press; Volume: 18; Issue: 1 Linguagem: Inglês

10.1093/ehjci/jew021

2047-2412

Jamil Cade, Gilberto Szarf, Maria Eduarda Menezes de Siqueira, Áurea J. Chaves, Júlio Andrea, Hélio Roque Figueira, Manuel M.R. Gomes, Bárbara Palma Freitas, Juliana Filgueiras Medeiros, Márcio Ricardo dos Santos, Walter Beneduzzi Fiorotto, Augusto Daige, Rosaly Gonçalves, Marcelo José de Carvalho Cantarelli, Cláudia Maria Rodrigues Alves, Leandro Santini Echenique, Fábio Sândoli de Brito, Marco Perin, Daniel Born, Harvey Hecht, Adriano Caixeta,

Pulmonary Hypertension Research and Treatments

Aims We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. Methods and results Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient. Conclusion In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.