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

Abstract

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.

The Young Heart Tears Easily Apart: A Case Report of Spontaneous Coronary Artery Dissection

“…SCAD is one of the major causes of ACS in pregnancy [5]. Pregnancy related SCAD (P-SCAD) is defined as SCAD during pregnancy or less than 12 weeks postpartum, and occurs mostly within one to two weeks after delivery [2,3,5]. P-SCAD presents with more ST-T wave segment changes and multivessel disease [5].…”

“…Pregnancy related SCAD (P-SCAD) is defined as SCAD during pregnancy or less than 12 weeks postpartum, and occurs mostly within one to two weeks after delivery [2,3,5]. P-SCAD presents with more ST-T wave segment changes and multivessel disease [5]. In their systematic review on P-SCAD, Paratz et al described increasing incidence of P-SCAD in primigravidas in the recent years.…”

“…In their systematic review on P-SCAD, Paratz et al described increasing incidence of P-SCAD in primigravidas in the recent years. A study from Mayo clinic SCAD registry by Tweet et al described that the incidence of P-SCAD is more in multiparous women overall [5,6]. In patients with P-SCAD, there is a significant upward trend towards caesarean section with better maternal and fetal outcomes [5].…”

“…A study from Mayo clinic SCAD registry by Tweet et al described that the incidence of P-SCAD is more in multiparous women overall [5,6]. In patients with P-SCAD, there is a significant upward trend towards caesarean section with better maternal and fetal outcomes [5]. Hormonal changes are also thought to have a role because of their presentation in young females and relation to menstruation [2,3,7].…”

Pregnancy associated spontaneous coronary artery dissection: A case report and review of literature

“…Previously considered a universally fatal condition, survival outcomes of PSCAD have improved in the past decades due to advances in the management of acute myocardial infarction. Maternal mortality rates are still high and variable in PSCAD patients, with one recent study reporting in-hospital mortality rates of 4.5%[ 30 , 31 ]. In another recent series of 750 patients containing 34 peripartum patients, PSCAD was associated with a higher rate of major adverse events (20.6%) such as Stroke/TIA, all-cause mortality, re-infection, Cardiogenic shock, congestive heart failure and cardiac arrest[ 20 ].…”