Pregnancy-Associated Spontaneous Coronary Artery Dissection Represents an Exceptionally High-Risk Spontaneous Coronary Artery Dissection Cohort
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
- myocardial infarction
- pregnancy and postpartum
- spontaneous coronary artery dissection
Acute myocardial infarction (MI) is a rare complication of pregnancy affecting 6 per 100 000 deliveries based on the US Nationwide Inpatient Sample hospital administrative database, and this risk seems to be 3- to 4-fold higher compared with that of nonpregnant women of similar age.1 Furthermore, an updated analysis from the same database reported pregnancy-associated spontaneous coronary artery dissection (PASCAD) affecting 1.81 per 100 000 pregnancies, although this may represent an underestimation of the true prevalence.2 A contemporary literature review of 134 cases of pregnancy-related MI identified spontaneous coronary artery dissection (SCAD) as the most important and underlying cause in ≈40%, being more common than atherosclerosis, thromboembolism, vasospasm, or Takotsubo syndrome in this cohort.3 Even though SCAD is an infrequent cause of MI in the general population (estimated at 1.7%–4%), its relative prominence is magnified in the enriched population of young women, accounting for 24% to 35% of MI in women aged ≤50 years old4 and even higher prevalence in women with pregnancy-related MI.3 Furthermore, previous reports also alluded to higher acuity and worse prognosis with PASCAD compared with nonpregnancy-related SCAD cases.5 Therefore, while PASCAD accounts for only <5% of SCAD cases in contemporary series, it represents a unique child-bearing cohort of the nonatherosclerotic SCAD population, affecting younger women than average SCAD patients, with additional challenges of adverse morbidities. This highlights the need to improve our understanding of PASCAD, especially the differences in the underlying pathophysiology, severity of presentation, acute and long-term cardiovascular outcomes, and management, compared with nonpregnancy-related forms of SCAD.
See Article by Havakuk et al
PASCAD can occur during pregnancy (antepartum; as early as 2 weeks postconception) or postpartum.6 The upper timing limit that constitutes postpartum PASCAD is not well defined, and cases of SCAD occurring several months after labor and delivery …