Publication details

Pregnancy and Spontaneous Coronary Artery Dissection: Lessons From Survivors and Nonsurvivors

Authors	CHAN Nathan PREMAWARDHANA Diluka AL-HUSSAINI Abtehale WOOD Alice BOUNTZIOUKA Vasiliki KOTECHA Deevia SWAHN Eva PALMEFORS Henning PAGONIS Christos LAWESSON Sofia Sederholm KADZIELA Jacek GARCIA-GUIMARAES Marcos ALFONSO Fernando ESCANED Javier MACAYA Fernando SANTAS Melisa CERRATO Enrico MAAS Angela H E M HLINOMAZ Ota BOGALE Nigussie CORTESE Bernardo CHENG Mavis BOLGER Aidan HUSSAIN Shazia T SAMANI Nilesh J KNIGHT Marian CAULDWELL Matthew ADLAM David
Year of publication	2022
Type	Article in Periodical
Magazine / Source	Circulation
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.059635
Doi	http://dx.doi.org/10.1161/CIRCULATIONAHA.122.059635
Keywords	coronary vessels; maternal death; myocardial infarction; pregnancy
Description	Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction associated with pregnancy (P-SCAD). It is also an understudied cause of maternal death. The present study aimed to report clinical presentation and management of P-SCAD in survivors and non-survivors and to investigate the outcome of pregnancies in women with previous SCAD. Patients were recruited from European SCAD registries with SCAD events from 1984 to 2021. All registries were approved by national or institutional ethical review boards. All patients gave written informed consent. The P-SCAD case series consisted of 82 patients (median age, 36 years [interquartile range, 5]; 94% never/former smokers, 85% White, 15% with hypertension, 5% with diabetes, 13% with dyslipidemia, 2% with previous stroke, 22% with family history of coronary artery disease,16% with extracoronary arteriopathies, and 48% with incomplete screening). Patients were alive at the time of enrollment and presented with SCAD confirmed on invasive angiography occurring during pregnancy or within 12 months of delivery, miscarriage, or termination. The pregnancy after previous SCAD series consisted of 37 pregnancies in 28 patients with angiographically confirmed SCAD who reported a subsequent pregnancy, whether ending in live birth, miscarriage, or termination. Data on 13 patients who did not survive P-SCAD were collected from the MBRRACE-UK audit of maternal deaths. The timing of SCAD in the P-SCAD case series is shown in the Figure. Few (n = 5) SCAD events occurred during pregnancy, with the peak time of vulnerability the first month after delivery. One patient had P-SCAD 4 months after miscarriage during her first trimester. Another had P-SCAD 3 weeks after medical termination.