Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients

Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients

Author Cade, Jamil Ribeiro Autor UNIFESP Google Scholar
Szarf, Gilberto Autor UNIFESP Google Scholar
Siqueira, Maria Eduarda Menezes de Autor UNIFESP Google Scholar
Chaves, Aurea Google Scholar
Andrea, Julio C. M. Google Scholar
Figueira, Helio R. Google Scholar
Gomes Junior, Manuel Pereira Marques Autor UNIFESP Google Scholar
Freitas, Barbara P. Google Scholar
Medeiros, Juliana Filgueiras Autor UNIFESP Google Scholar
dos Santos, Marcio Ricardo Google Scholar
Fiorotto, Walter B. Google Scholar
Daige, Augusto Google Scholar
Goncalves, Rosaly Google Scholar
Cantarelli, Marcelo Google Scholar
Alves, Claudia Maria Rodrigues Autor UNIFESP Google Scholar
Echenique, Leandro Autor UNIFESP Google Scholar
Fabio, S. de Brito Google Scholar
Perin, Marco A. Google Scholar
Born, Daniel Autor UNIFESP Google Scholar
Hecht, Harvey Google Scholar
Caixeta, Adriano Autor UNIFESP Google Scholar
Abstract Aims We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. Methods and results Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 3.7 years

most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEM!, and one presented with unstable angina

one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically

percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient Conclusion In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.
Keywords spontaneous coronary artery dissection
acute myocardial infarction
optical coherence tomography
intravascular ultrasound
xmlui.dri2xhtml.METS-1.0.item-coverage Oxford
Language English
Sponsor Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Date 2017
Published in European Heart Journal-Cardiovascular Imaging. Oxford, v. 18, n. 1, p. 54-61, 2017.
ISSN 2047-2404 (Sherpa/Romeo, impact factor)
Publisher Oxford Univ Press
Extent 54-61
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000397065800007

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