Association of Pregnancy With Recurrence of Spontaneous Coronary Artery Dissection Among Women With Prior Coronary Artery Dissection

Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman’s risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).

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“…In women with a prior SCAD, a new pregnancy seems to be well tolerated without evidence of an increased risk of SCAD recurrence. 212 …”

Section: Pregnancy-related Disorders and Cardiovascular Disease Riskmentioning

confidence: 99%

Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists

Maas

Rosano

Cífková

et al. 2021

European Heart Journal

196

128

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“…Whether pregnancy is associated with SCAD recurrences is unknown, since this association has been reported only in case series [54]. However, since SCAD is a prevalent cause of MI in pregnant women and pregnancy-related SCAD has a more severe course, counselling for women pregnancy seeking should be warranted.…”

Section: Scad Recurrencementioning

confidence: 99%

Spontaneous Coronary Artery Dissections: A Systematic Review

Teruzzi

Baldi

Gili

et al. 2021

JCM

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Myocardial infarction with nonobstructive coronary artery disease due to spontaneous coronary artery dissection (SCAD) accounts for 5–8% of acute coronary syndrome (ACS) presentations. The demographic characteristics, risk factors, and management of patients with SCAD differ from those with atherosclerotic disease. The objective of this review is to provide a contemporary understanding of the epidemiology, pathophysiology, clinical presentation, and management of SCAD.

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“…The Mayo Clinic SCAD Registry is described in more detail elsewhere. 12 Repeat and follow-up CTAs were not included as part of this analysis. MRAs were also not included to optimize the homogeneity of imaging interpretation.…”

Section: Patient Selectionmentioning

confidence: 99%

Prevalence of Cervical Artery Abnormalities on CTA in Patients with Spontaneous Coronary Artery Dissection: Fibromuscular Dysplasia, Dissection, Aneurysm, and Tortuosity

Benson

Lehman

Verdoorn

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Little is known about associations between spontaneous coronary artery dissection and cervical artery abnormalities. This study sought to assess the prevalence of cervical artery abnormalities among patients with spontaneous coronary artery dissection. MATERIALS AND METHODS:A retrospective analysis was completed of patients who underwent CTA neck imaging as part of arterial assessment following the diagnosis of spontaneous coronary artery dissection. The internal carotid and vertebral arteries were evaluated for the presence of fibromuscular dysplasia, dissection and/or pseudoaneurysm, ectasia and/or aneurysmal dilation, atherosclerosis, and webs. Carotid tortuosity was categorized into kinks, loops, coils, and retrojugular and/or retropharyngeal carotid courses; vertebral tortuosity was classified by subjective analysis of severity.RESULTS: Two hundred fourteen patients were included in the final cohort, of whom 205 (95.8%) were women; the average age was 54.4 years. Fibromuscular dysplasia was the most frequently observed abnormality (83 patients; 38.8%), followed by dissections and/or pseudoaneurysms (n ¼ 28; 13.1%), ectasia and/or aneurysmal dilation (n ¼ 22; 10.3%), and carotid webs (n ¼ 10; 4.7%). At least 1 type of carotid tortuosity was present in 99 patients (46.3%). The majority (n ¼ 185; 86.4%) of patients had no carotid atherosclerosis; and 26 (12.2%) had mild; 3 (1.4%), moderate; and 0, severe carotid atherosclerosis. CONCLUSIONS:The most common abnormality in the cervical artery vasculature of patients with spontaneous coronary artery dissection is fibromuscular dysplasia. Cervical dissections were higher than previously reported but were not observed in most patients. ABBREVIATIONS: ACS ¼ acute coronary syndrome; CTD ¼ connective tissue disorder; FMD ¼ fibromuscular dysplasia; SCAD ¼ spontaneous coronary artery dissection S pontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS), predominantly affecting otherwise healthy young and middleaged women. 1,2 By definition, it refers to dissection of the coronary artery wall in the absence of trauma, atherosclerosis, or iatrogenic causes. 3 The resultant intramural hematoma and/or intimal flap can cause substantial luminal narrowing, leading to myocardial ischemia and infarction. Once considered rare, SCAD is now thought to be the cause of up to 4% of cases of ACS and up to 35% of cases of ACS in women younger than of 50 years of age. 4,5 Furthermore, there is evidence that the incidence of SCAD has increased during the past decades. 6

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Association of Pregnancy With Recurrence of Spontaneous Coronary Artery Dissection Among Women With Prior Coronary Artery Dissection

Abstract: This nested case-control study uses data from the Mayo Clinic Spontaneous Coronary Artery Dissection Registry to investigate the association of pregnancy with spontaneous coronary artery dissection recurrence among women with a history of coronary artery dissection.

Cited by 50 publications

References 28 publications

Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists

Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists

Spontaneous Coronary Artery Dissections: A Systematic Review

Prevalence of Cervical Artery Abnormalities on CTA in Patients with Spontaneous Coronary Artery Dissection: Fibromuscular Dysplasia, Dissection, Aneurysm, and Tortuosity

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