Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Small study finds recurrent spontaneous coronary artery dissection risk not associated with subsequent pregnancy
Clinical Question
Does pregnancy increase the risk of recurrent spontaneous coronary artery dissection (SCAD) in women with a history of SCAD?
Bottom line
This study found a recurrent SCAD rate of 14.8% at 5 years in women with a history of SCAD, with no significant association between subsequent pregnancy and SCAD recurrence. In addition, most women had minimal to no complications with pregnancy or lactation after SCAD. This study is limited, however, by the small number of women with pregnancy after SCAD (n = 23). 3b
Reference
Study design: Case-control
Funding: Government
Setting: Population-based
Synopsis
SCAD is a nonatherosclerotic cause of acute coronary syndrome (ACS) that occurs in women of childbearing age. SCAD recurrence is defined as ACS or cardiac arrest due to SCAD in a different coronary artery. Risk factors for SCAD recurrence and effective prevention measures are unknown. These investigators analyzed data obtained from an international registry of patients who met standard diagnostic criteria for SCAD. The initial cohort consisted of 636 women of childbearing age and potential with a history of SCAD. Of these, 23 women (median age 38 years; range 34 to 40 years) had a total of 32 pregnancies and 2 of these women (9%) experienced recurrent SCAD. A total of 92 cases of recurrent SCAD, defined as those with a recurrence at least 1 month after the initial SCAD, were matched to 158 control patients with no history of recurrence on the basis of age, year of first SCAD, and the presence or absence of fibromuscular dysplasia on coronary imaging. No significant difference occurred in the number of subsequent pregnancies in the women with recurrent SCAD (cases) compared with matched control patients (2% vs 8%; P = NS).
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
coronary artery dissection
I do not recall seeing this in my practice
coronary artery dissection in pregnancy
no increased risk with pregnancy in pts with SCAD