Patients with pregnancy-associated spontaneous coronary artery dissection experienced more severe clinical presentations compared with those with nonpregnancy spontaneous coronary artery dissection and had higher rates of in-hospital major adverse cardiovascular events, according to new research.
Researchers found that pregnancy-associated spontaneous coronary artery dissection (P-SCAD) was linked to higher rates of ST-segment elevation myocardial infarction (STEMI), fertility treatment use, and preeclampsia. Despite these differences, most of the patients in both groups were managed conservatively.
The study included patients diagnosed with SCAD and compared pregnancy-associated cases with those unrelated to pregnancy.
More Severe Presentation in P-SCAD
STEMI occurred in 18.6% of patients with P-SCAD compared with 5.5% of those with nonpregnancy SCAD.
Pregnancy-associated cases were also more likely to involve multivessel and multisegment disease, indicating a more severe presentation.
The patients with P-SCAD were more likely to have a history of more than five pregnancies. In contrast, fibromuscular dysplasia was less common in this group.
No left main coronary artery involvement was identified among the patients with P-SCAD.
Management and In-Hospital Outcomes
Most of the patients in both groups were treated conservatively rather than with revascularization.
However, the patients with P-SCAD had higher rates of in-hospital major adverse cardiovascular events compared with those with nonpregnancy SCAD, driven largely by recurrent myocardial infarction.
Left Ventricular Function Recovery
The patients with P-SCAD were more likely to present with more severe left ventricular ejectionf fraction and have persistent dysfunction at 1 year.
Although small sample sizes may have limited the study's interpretation, a greater proportion of patients with P-SCAD had left ventricular ejection fraction (LVEF) below 50% at 1 year, consistent with overall less recovery reported by the investigators.
Clinical Implications
The findings highlighted important differences in the presentation of SCAD between those with pregnancy-associated and nonpregnancy-associated disease while suggesting that conservative management remains common in both groups.
The investigators noted that further studies are needed to better understand long-term recovery and optimal management in this patient population.
Full disclosures can be found in the study.
Source: JAMA Cardiology
