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

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

doi:10.1093/ehjci/jew021

Cited by 43 publications

(49 citation statements)

References 29 publications

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“…35,85,86,88–90 The left main or left anterior descending artery has been described as the most commonly affected. 17,35,85,86,89,91,92 …”

Section: Pathogenesis Of Scad and Scad-associated Conditionsmentioning

confidence: 99%

“…86,87 The average age at the time of pregnancy-associated SCAD has ranged from 33 to 36 years, a finding highlighting the potential impact of older age at time of pregnancy on cardiovascular complications such as SCAD. 85,86,88,89,95 Because maternal age and multiparity are associated, the independent contribution of these factors to SCAD risk is uncertain.…”

Section: Pathogenesis Of Scad and Scad-associated Conditionsmentioning

confidence: 99%

“…85,86,88,89 In a series of 23 women with SCAD, 7 of whom had pregnancy-associated SCAD, postpartum patients had larger infarcts, more proximal artery dissections (86% versus 19%; P <.004), and lower mean left ventricular (LV) ejection fraction (34% versus 49%; P <0.01). 85 In the Mayo Clinic SCAD Registry, 54 women with pregnancy-associated SCAD were compared with 269 women with non–pregnancy-associated SCAD.…”

Section: Pathogenesis Of Scad and Scad-associated Conditionsmentioning

confidence: 99%

See 2 more Smart Citations

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Hayes¹,

Kim²,

Saw³

et al. 2018

Circulation

831

1,210

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Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.

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“…35,85,86,88–90 The left main or left anterior descending artery has been described as the most commonly affected. 17,35,85,86,89,91,92 …”

Section: Pathogenesis Of Scad and Scad-associated Conditionsmentioning

confidence: 99%

Section: Pathogenesis Of Scad and Scad-associated Conditionsmentioning

confidence: 99%

Section: Pathogenesis Of Scad and Scad-associated Conditionsmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Hayes¹,

Kim²,

Saw³

et al. 2018

Circulation

831

1,210

View full text Add to dashboard Cite

show abstract

“…Contributions such as the data obtained from the survey made by a group of SCAD experts and the European Society of Cardiology SCAD Working Group serves as an example of ongoing efforts to better understand the diagnosis, therapy, and follow‐up in SCAD . Several different predisposing disease processes and risk factors have been associated with SCAD to date, including fibromuscular dysplasia, inherited connective tissue disorders (e.g., Marfan's syndrome, Ehlers‐Danlos syndrome type IV, and Loeys‐Dietz syndrome), systemic inflammatory disorders (e.g., systemic lupus erythematosus, inflammatory bowel disease, polyarteritis nodosa), oral contraceptives, hormonal replacement therapy, extreme emotional stress and/or intense physical exertion, drugs (e.g., cocaine, methamphetamine, marijuana), and pregnancy specifically the post‐partum/peripartum period …”

Section: Introductionmentioning

confidence: 99%

Spontaneous coronary artery dissection and its association with takotsubo syndrome: Novel insights from a tertiary center registry

Duran

Naderi

Vidula

et al. 2019

Cathet Cardio Intervent

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Background Spontaneous coronary artery dissection (SCAD) is a relatively rare cause of acute coronary syndrome historically thought to primarily affect young, healthy women. The lack of multicenter collaborative research efforts has made it challenging to identify the precise etiology and pathological mechanisms underlying SCAD. However, there are many similarities in the patient demographics, clinical presentations, and predisposing stressors between SCAD and takotsubo syndrome (TTS). Objectives The aim of this observational study was to examine the coronary and left ventriculographic features of patients with angiographically confirmed SCAD and determine the prevalence of concomitant TTS. Methods In this observational study, patients with angiographically confirmed SCAD were identified from the Massachusetts General Hospital SCAD registry. The coronary angiograms with simultaneous left ventriculograms (LVG) were carefully analyzed by an independent and blinded angiographic core laboratory. Results From our analysis of patients with SCAD who also underwent a LVG at time of coronary angiography, we identified a high prevalence of SCAD and concomitant TTS. Conclusions Therefore, we present TTS as a plausible mechanistic etiology for SCAD in some patients. In light of this finding as well as the many similarities between SCAD and TTS, clinicians should be vigilant about the potential concomitant presence of these two entities. Additional future investigations further exploring the clinical implications of the association between SCAD and TTS are warranted.

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“…Exclusion of duplicate results and articles not meeting specified a priori criteria (162 articles) resulted in 111 articles describing 138 cases of P-SCAD [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], …”

Section: Methodsmentioning

confidence: 99%

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Paratz

Kao

MacIsaac

et al. 2018

IJC Heart & Vasculature

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BackgroundPregnancy-associated spontaneous coronary artery dissection (P-SCAD) is defined as SCAD occurring during pregnancy or within 3 months post-partum. Earlier systematic reviews have suggested a high maternal and foetal mortality rate. We undertook a structured systematic review of P-SCAD demographics, management and maternal and foetal outcomes.MethodsCase study identification was conducted according to PRISMA guidelines, with screening of all published P-SCAD cases not meeting pre-defined exclusion criteria. Of two hundred and seventy-three publications screened, one hundred and thirty-eight cases met inclusion criteria. Cases were allocated to one of three time periods; 1960–85 (twenty cases) reflecting early management of P-SCAD, 1986–2005 (forty-two cases) reflecting recent management, and 2006–16 (seventy-six cases), reflecting contemporary management.ResultsThe only significant demographic change in women experiencing P-SCAD over the last 50 years was an increasing proportion of primigravidas (p = 0.02). Management and outcomes, however, have altered significantly. Emergent angiography (p < 0.0001), reduced thrombolysis (p = 0.006) and increasingly conservative or percutaneous management (p < 0.0001) are associated with dramatic reductions in maternal mortality (85% in earliest reports to 4% in the last decade, p < 0.0001) and foetal mortality (50% in earliest reports to 0.0% in the last decade, p = 0.023).ConclusionThis systematic review of temporal changes in presentation, management and outcomes of P-SCAD represents the widest range of variables analysed in the largest cohort of P-SCAD patients to date. In the setting of earlier coronary angiography and increasingly conservative management, maternal and foetal survival rates continue to improve.

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

Cited by 43 publications

References 29 publications

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Spontaneous coronary artery dissection and its association with takotsubo syndrome: Novel insights from a tertiary center registry

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

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