In the Journals

Pregnancy-related spontaneous coronary artery dissection confers severe acute events

Women who had spontaneous coronary artery dissection during or after their pregnancy were more likely to have high-risk features and acute presentations compared with those who had spontaneous coronary artery dissection not associated with pregnancy, according to a study published in the Journal of the American College of Cardiology.

Marysia S. Tweet, MD, assistant professor of medicine and senior associate consultant in the division of cardiovascular diseases at Mayo Clinic in Rochester, Minnesota, and colleagues analyzed data from 323 women with spontaneous coronary artery dissection, of whom 54 had the event during pregnancy or 4 weeks’ postpartum. Women who had spontaneous coronary artery dissection not associated with pregnancy (n = 269) had the event from 4 to 12 weeks’ postpartum.

Acute dissection events

Most spontaneous coronary artery dissections occurred within the first month after delivery or miscarriage (70%). Women with spontaneous coronary artery dissection during or shortly after pregnancy who had vascular imaging had fewer cases of fibromuscular dysplasia (42%) vs. those with events not associated with pregnancy (64%; P = .047). Extracoronary vascular abnormalities were more common in events not related to pregnancy (77%) compared with events that occurred during or shortly after pregnancy (46%; P = .0032).

Compared with other women in the U.S. at childbearing age, women with spontaneous coronary artery dissections during or shortly after pregnancy were more often multiparous (80% vs. 64%; P = .0167), had preeclampsia (11% vs. 3.4%; P = .001) and had a history of infertility therapies (28% vs. 12%; P = .0004).

Women with events during or shortly after pregnancy had STEMI more often that women with events not associated with pregnancy (57% vs. 36%; P = .009). Compared with women with events not related to pregnancy, women with events during or after pregnancy were more likely to have left main (24% vs. 5%; P < 0001) or multiple-vessel spontaneous coronary dissections (33% vs. 14%; P = .0027) and left ventricular function at 35% or less (26% vs. 10%; P = .0071).

At follow-up (median, 2.3 years), no deaths occurred and eight women with spontaneous coronary artery dissection during or shortly after pregnancy had a recurrent event. Kaplan-Meier 5-year recurrence rates did not differ between the group with events during or after pregnancy (10%) and events not related to pregnancy (23%; P = .18).

Further research

“Variations in hemodynamic and hormonal factors might contribute to [spontaneous coronary artery dissection] events in susceptible women,” Tweet and colleagues wrote, noting the study prompts “consideration of yet-undefined pathophysiological mechanisms intrinsic to pregnancy.”

Heather Gornik
Heather L. Gornik

In a related editorial, Heather L. Gornik, MD, staff physician in the Robert and Suzanne Tomsich department of cardiovascular medicine and medical director of the noninvasive vascular laboratory at the Cleveland Clinic’s Sydell and Arnold Miller Family Heart and Vascular Institute, wrote, “I hope the field has now achieved adequate momentum, and that we will soon see an exponential proliferation of clinical and translational search studies to further understand the pathogenesis of [spontaneous coronary artery dissection], to identify mechanisms for primary and secondary prevention and to determine the best treatment approach.” – by Darlene Dobkowski

Disclosures: The study was funded by the Mayo Clinic Department of Cardiovascular Diseases and SCAD Research Inc. The authors and Gornik report no relevant financial disclosures.

Women who had spontaneous coronary artery dissection during or after their pregnancy were more likely to have high-risk features and acute presentations compared with those who had spontaneous coronary artery dissection not associated with pregnancy, according to a study published in the Journal of the American College of Cardiology.

Marysia S. Tweet, MD, assistant professor of medicine and senior associate consultant in the division of cardiovascular diseases at Mayo Clinic in Rochester, Minnesota, and colleagues analyzed data from 323 women with spontaneous coronary artery dissection, of whom 54 had the event during pregnancy or 4 weeks’ postpartum. Women who had spontaneous coronary artery dissection not associated with pregnancy (n = 269) had the event from 4 to 12 weeks’ postpartum.

Acute dissection events

Most spontaneous coronary artery dissections occurred within the first month after delivery or miscarriage (70%). Women with spontaneous coronary artery dissection during or shortly after pregnancy who had vascular imaging had fewer cases of fibromuscular dysplasia (42%) vs. those with events not associated with pregnancy (64%; P = .047). Extracoronary vascular abnormalities were more common in events not related to pregnancy (77%) compared with events that occurred during or shortly after pregnancy (46%; P = .0032).

Compared with other women in the U.S. at childbearing age, women with spontaneous coronary artery dissections during or shortly after pregnancy were more often multiparous (80% vs. 64%; P = .0167), had preeclampsia (11% vs. 3.4%; P = .001) and had a history of infertility therapies (28% vs. 12%; P = .0004).

Women with events during or shortly after pregnancy had STEMI more often that women with events not associated with pregnancy (57% vs. 36%; P = .009). Compared with women with events not related to pregnancy, women with events during or after pregnancy were more likely to have left main (24% vs. 5%; P < 0001) or multiple-vessel spontaneous coronary dissections (33% vs. 14%; P = .0027) and left ventricular function at 35% or less (26% vs. 10%; P = .0071).

At follow-up (median, 2.3 years), no deaths occurred and eight women with spontaneous coronary artery dissection during or shortly after pregnancy had a recurrent event. Kaplan-Meier 5-year recurrence rates did not differ between the group with events during or after pregnancy (10%) and events not related to pregnancy (23%; P = .18).

Further research

“Variations in hemodynamic and hormonal factors might contribute to [spontaneous coronary artery dissection] events in susceptible women,” Tweet and colleagues wrote, noting the study prompts “consideration of yet-undefined pathophysiological mechanisms intrinsic to pregnancy.”

Heather Gornik
Heather L. Gornik

In a related editorial, Heather L. Gornik, MD, staff physician in the Robert and Suzanne Tomsich department of cardiovascular medicine and medical director of the noninvasive vascular laboratory at the Cleveland Clinic’s Sydell and Arnold Miller Family Heart and Vascular Institute, wrote, “I hope the field has now achieved adequate momentum, and that we will soon see an exponential proliferation of clinical and translational search studies to further understand the pathogenesis of [spontaneous coronary artery dissection], to identify mechanisms for primary and secondary prevention and to determine the best treatment approach.” – by Darlene Dobkowski

Disclosures: The study was funded by the Mayo Clinic Department of Cardiovascular Diseases and SCAD Research Inc. The authors and Gornik report no relevant financial disclosures.