Pregnancy-Associated Spontaneous Coronary Artery Dissection in Women: A Literature Review

Zeven, Katherine

doi:10.1016/j.curtheres.2023.100697

Cited by 10 publications

(18 citation statements)

References 53 publications

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“…Zeven et al found that patients at a third trimester have a highest risk for SCAD. In other studies the highest incidence of SCAD was reported in so called peripartum (which includes delivery and 1 week after delivery) and postpartum period up to 30 days after giving birth ( 2 ). The most frequent contributing factors for P-SCAD include genetics, hormonal influences, systemic inflammatory diseases, inherited or acquired arteriopathies, and environmental factors.…”

Section: Discussionmentioning

confidence: 95%

“…Currently, the scientific community works with limited information about P-SCAD, and a major dilemma is the optimal treatment. While some of the authors suggest that conservative treatment is by far superior to percutaneous intervention ( 42 ), there are some scenarios where invasive treatment may be a better option for acute management of P-SCAD ( 2 , 43 ). The rarity of this entity and the lack of randomized studies, and the complications of invasive treatment make it challenging to choose between conservative management, PCI or CABG ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

“…Since the precise mechanisms of the thienopyridine derivatives elimination route is unknown, the use of clopidogrel is not recommended during breastfeeding ( 48 , 49 ). Also, prescription of thienopyridine derivatives should be done carefully in premenopausal women due to high risk of menorrhagia ( 2 , 50 ). As well established, use of low-dose acetylsalicylic acid (<150 mg) in the second and third trimesters is safe ( 48 , 51 ).…”

Section: Discussionmentioning

confidence: 99%

“…Despite their early usage for SCAD treatment, thrombolytic agents are not recommended because of the risk of dissection expansion and worsening of coronary spasm leading to coronary rupture ( 2 , 54 ).…”

Section: Discussionmentioning

confidence: 99%

“…Potential predisposing factors include fibromuscular dysplasia (FMD), partum and postpartum period, multi-parity (≥4 births), connective tissue disorders, systemic inflammatory conditions, mental stress and hormonal therapy. While uncommon, SCAD should be considered in any young patient, especially young women without a history of coronary heart disease or traditional risk factors, who presents with an acute myocardial infarction or cardiac arrest ( 1 , 2 ).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Spontaneous coronary artery dissection in women in the generative period: clinical characteristics, treatment, and outcome—a systematic review and meta-analysis

Apostolović,

Ignjatović,

Stanojević

et al. 2024

Front. Cardiovasc. Med.

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IntroductionSpontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary arterial wall.Materials and methodsThis systematic review and meta-analysis is reported following the PRISMA guidelines and is registered in the PROSPERO database. A literature search was focused on female patients in generative period (16–55 of age) with acute coronary syndrome (ACS) caused by SCAD, and comparison from that database NP-SCAD (spontaneous coronary artery dissection in non pregnant women) and P-SCAD (spontaneous coronary artery dissection in pregnant women).Results14 studies with 2,145 females in the generative period with ACS caused by SCAD were analyzed. The median age was 41 years (33.4–52.3 years). The most common risk factor was previous smoking history in 24.9% cases. The most common clinical presentation of ACS was STEMI in 47.4%. Conservative treatment was reported in 41.1%. PCI was performed in 32.7%, and 3.8% of patients had CABG surgery. LAD was the most frequently affected (50.5%). The prevalence of composite clinical outcomes including mortality, non-fatal MI and recurrent SCAD was 3.3% (95% CI: 1.4–5.1), 37.7% (95% CI: 1.9–73.4) and 15.2% (95% CI: 9.1–21.3) of patients. P-SCAD compared to NP-SCAD patients more frequently had STEMI (OR = 3.16; 95% CI: 2.30–4.34; I2 = 64%); with the left main and LAD more frequently affected [(OR = 14.34; 95% CI: 7.71–26.67; I2 = 54%) and (OR = 1.57; 95% CI: 1.06–2.32; I2 = 23%)]; P-SCAD patients more frequently underwent CABG surgery (OR = 6.29; 95% CI: 4.08–9.70; I2 = 0%). NP-SCAD compared to P-SCAD patients were more frequently treated conservatevly (OR = 0.61; 95% CI: 0.37–0.98; I2 = 0%). In P-SCAD compared to NP-SCAD mortality rates (OR = 1.13; 95% CI: 0.06–21.16; I2 = not applicable) and reccurence of coronary artery dissection (OR = 2.54; 95% CI: 0.97–6.61; I2 = 0%) were not more prevalent.ConclusionThe results of this meta-analysis indicated that patients with P-SCAD more frequently had STEMI, and events more frequently involved left main and LAD compared to NP-SCAD patients. Women with NP-SCAD were significantly more often treated conservatively compared to P-SCAD patients. P-SCAD compared to NP-SCAD patients did not have significantly higher mortality rates or recurrent coronary dissection.

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Section: Discussionmentioning

confidence: 95%