Coronary angiography of pregnancy-associated coronary artery dissection: a high-risk procedure

Martins, Raphaël P.; Leurent, Guillaume; Fouquet, Olivier; Seconda, Sébastien; Baruteau, Alban‐Elouen; Moreau, Olivier; Breton, Hervé; Bédossa, Marc

doi:10.1016/j.carrev.2009.03.002

Cited by 13 publications

(5 citation statements)

References 9 publications

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“…Exclusion of duplicate results and articles not meeting specified a priori criteria (162 articles) resulted in 111 articles describing 138 cases of P-SCAD [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], …”

Section: Methodsmentioning

confidence: 99%

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Paratz

Kao

MacIsaac

et al. 2018

IJC Heart & Vasculature

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BackgroundPregnancy-associated spontaneous coronary artery dissection (P-SCAD) is defined as SCAD occurring during pregnancy or within 3 months post-partum. Earlier systematic reviews have suggested a high maternal and foetal mortality rate. We undertook a structured systematic review of P-SCAD demographics, management and maternal and foetal outcomes.MethodsCase study identification was conducted according to PRISMA guidelines, with screening of all published P-SCAD cases not meeting pre-defined exclusion criteria. Of two hundred and seventy-three publications screened, one hundred and thirty-eight cases met inclusion criteria. Cases were allocated to one of three time periods; 1960–85 (twenty cases) reflecting early management of P-SCAD, 1986–2005 (forty-two cases) reflecting recent management, and 2006–16 (seventy-six cases), reflecting contemporary management.ResultsThe only significant demographic change in women experiencing P-SCAD over the last 50 years was an increasing proportion of primigravidas (p = 0.02). Management and outcomes, however, have altered significantly. Emergent angiography (p < 0.0001), reduced thrombolysis (p = 0.006) and increasingly conservative or percutaneous management (p < 0.0001) are associated with dramatic reductions in maternal mortality (85% in earliest reports to 4% in the last decade, p < 0.0001) and foetal mortality (50% in earliest reports to 0.0% in the last decade, p = 0.023).ConclusionThis systematic review of temporal changes in presentation, management and outcomes of P-SCAD represents the widest range of variables analysed in the largest cohort of P-SCAD patients to date. In the setting of earlier coronary angiography and increasingly conservative management, maternal and foetal survival rates continue to improve.

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Section: Methodsmentioning

confidence: 99%

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Paratz

Kao

MacIsaac

et al. 2018

IJC Heart & Vasculature

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“…For details, see Supplementary material online. [191][192][193][194][195][196][197][198][199][200][201][202][203][204][205][206][207][208]…”

Section: Adjunctive Supportive Devices and Transplantmentioning

confidence: 99%

European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection

Adlam

Alfonso

Maas

et al. 2018

European Heart Journal

512

656

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“…28 However, angiography, catheterisation and other invasive therapies should be performed with great caution, as any force applied to the extremely fragile coronary arteries of pregnant women may lead to an extension of the dissection. 29,30 The use of thrombolytic agents in pregnancy is best avoided in patients in whom dissection is suspected. The choice of treatment depends on the haemodynamic status of the patient, angiographic findings and the area of the myocardium at risk.…”

Section: 22mentioning

confidence: 99%

Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry

Chapelle¹,

Schutte

Schuitemaker

et al. 2011

BJOG

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Objective To determine the incidence of maternal deaths attributable to vascular dissection and rupture in the Netherlands, and to assess clinical features, risk factors and the frequency of substandard care in the cases identified.Design Confidential enquiry into the causes of maternal deaths.Setting Nationwide in the Netherlands. Results A total of 23 maternal deaths attributable to vascular dissection and rupture were reported. In most cases the location was aortic (n = 13), followed by coronary (n = 4) and splenic (n = 3) arteries. Clinical features were various, but most women presented with sudden unexplainable pain. Risk factors were present in 14 cases (61%), with hypertension being most frequently reported in ten cases (43%). Substandard care was determined to have been received in 13 cases (56%), inadequate assessment of complaints and a delay in diagnosis being the most frequent problems identified.Conclusions Vascular dissection and rupture in pregnancy, although rare, carry a high risk of maternal and fetal morbidity and mortality. Because of the rarity of this condition and its variety in presentation, diagnosis is easily missed. A high index of suspicion when a woman presents with suggestive complaints, leading to an early diagnosis, may improve the prognosis for the woman and her child.Keywords Aneurysm, aortic dissection, carotid artery dissection, coronary dissection, hepatic artery dissection, iliac artery dissection, maternal mortality, pregnancy-related, splenic artery dissection, substandard care, vascular dissection, vascular rupture.Please cite this paper as: la Chapelle C, Schutte J, Schuitemaker N, Steegers E, van Roosmalen J on behalf of the Dutch Maternal Mortality Commitee. Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry. BJOG 2012;119:86-93.

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Coronary angiography of pregnancy-associated coronary artery dissection: a high-risk procedure

Cited by 13 publications

References 9 publications

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection

Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry

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