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Pregnancy-associated spontaneous coronary artery dissection linked to maternal, fetal complications
Pregnancy-associated spontaneous coronary artery dissection is associated with involvement from the left anterior descending artery, the left main artery and multiple vessels, which can often lead to reduced ejection fraction, according to published findings.
“In contrast to the general population in whom atherosclerotic disease is the main cause of MI, spontaneous coronary dissection is the most common mechanism of pregnancy-associated MI and has been documented in more than 40% of cases,” Ofer Havakuk, MD, from the division of cardiovascular medicine, department of medicine and department of obstetrics and gynecology at the University of Southern California, and colleagues wrote.
Of the 120 cases of pregnancy-associated spontaneous coronary artery dissection from 2000 to 2015 included in the study, 75% presented with STEMI and 80% had anterior MI.
The left anterior descending coronary artery was involved in 72% of cases, the left main segment in 36%, and 40% of patients had multivessel spontaneous coronary artery dissection.
In 44% of cases, there was a reduction in ejection fraction to less than 40%.
The success rate for PCI cases was 50%, according to the researchers.
Forty-four cases required CABG because of complex anatomy, hemodynamic instability or failed PCI.
Patients experienced complications such as cardiogenic shock (24%), mechanical support (28%), urgent PCI (28%), urgent CABG (27.5%), maternal mortality (4%) and fetal mortality (2.5%), according to the researchers.
During follow-up of 305 ± 111 days, there was a high incidence of symptoms because of persistent or new spontaneous coronary artery dissections, and five women needed heart transplantation or ventricular assist device implantation.
The researchers recommended a close and long-term follow-up in women with pregnancy-associated spontaneous coronary artery dissection.
“The results of this study highlight the unique and important characteristics of [pregnancy-associated spontaneous coronary artery dissection] that should be taken into account by clinicians treating such patients,” the researchers wrote. “Little information is available on the risk of subsequent pregnancy in women with a history of [pregnancy-associated spontaneous coronary artery dissection]. However, because of the high incidence of recurrent [spontaneous coronary artery dissection] and pregnancy-related vulnerability of the coronary arteries, subsequent pregnancy does not seem advisable.” – by Dave Quaile
Disclosure: The researchers report no relevant financial disclosures.