Pregnancy associated spontaneous coronary artery dissection: A multicenter case series study

Abstract

Introduction

Pregnancy-associated (P-) spontaneous coronary artery dissection (SCAD) is a rare and underdiagnosed but a potentially lethal complication of pregnancy.

Objective

The aim of this study was to describe a case series with a highlight on management strategies and outcomes of 6 P-SCAD women.

Method

A retrospective analysis of data of six patients of P-SCAD managed in four tertiary care centers from January 2011 to June 2023 was done. Clinical, angiographic, therapeutic, and follow-up data were analyzed.

Results

All patients presented in the postpartum period, majority with severe initial clinical presentation: persistent and non-persistent ST segment elevation myocardial infarction were noted in 4 and 2 patients (of which 1 transient ST elevation myocardial infarction) respectively. Hemodynamic instability was reported in 3 patients: 2 cardiogenic shocks and 1 acute pulmonary oedema. Left main coronary artery (LMCA) and left anterior descending coronary artery were involved in 5 and 4 patients respectively. 5 out of 6 patients had multivessel dissections. All patients had angiographic type 1 SCAD angiographic pattern. 2 patients needed immediate primary (n = 1) or rescue (n = 1) percutaneous coronary intervention (PCI) with angiographic success. Conservative therapy was initially attempted in 4 patients with unfavorable evolution: dissection persistence (n = 2) and extension (n = 2). Dissection extension was associated with worsening clinical presentations with recurrent angina (n = 1) and cardiogenic shock (n = 1) mandating subsequent emergent PCI and coronary artery bypass grafting in the 2 patients respectively. Intra-aortic balloon pump (IABP) was inserted in 2 patients. In-hospital death occurred in 2 out of 6 patients.

Conclusion

P-SCAD women had severe clinical presentations. LMCA and multivessel involvement were often observed. Conservative strategy was attempted when it was possible with unfavorable angiographic outcome. Consequently, in-hospital mortality rate was as high as 33%.