Abstract 18201: Pregnancy Associated Acute Myocardial Infarction due to Spontaneous Coronary Dissection: Clinical Characteristics and Effect on Maternal and Fetal Outcome
Background: Spontaneous coronary dissection (SCAD) is the most common mechanism of pregnancy-associated myocardial infarction (MI). Because of the rarity of this condition, most available information on pregnancy associated SCAD (PASCAD) is limited.
Objectives: to review a large number of contemporary PASCAD cases in an attempt to define the clinical characteristics of this condition, and provide management recommendations.
Methods: A literature searches for cases of PASCAD reported between 2000 and 2015 were performed and data analyzed.
Results: 120 women with PASCAD were included. Mean age was 34±4 years with 81% > 30 years and 40.5% > 35 years. 75% Presented with STEMI and 80% had anterior MI. Left anterior descending (LAD) coronary artery was involved in 72% of cases, left main (LM) segment in 36% and 40% had multivessel SCAD. Mean left ventricular ejection fraction (LVEF) was reduced at 40±9% and was <40% in 44% of cases. Percutaneous coronary intervention (PCI) was successful in only 50% of cases. Coronary artery bypass (CABG) surgery was performed in 44 cases due to complex anatomy, hemodynamic instability or failed PCI. There was high rate of maternal complications including cardiogenic shock (24%), mechanical support (28%), urgent PCI (28%), urgent CABG surgery (27.5%) and maternal mortality (4%). Fetal complications included mortality in 3 cases. During average follow up of 305±111 days, there was a high incidence of recurrent symptoms due to persistent or new SCADs and 5 women needed heart transplantation or ventricular assist device implantation.
Conclusions: PASCAD is associated with a high incidence of LAD, LM and multi vessel involvement. It presents mostly with STEMI involving the anterior wall leading to a significant reduction in EF and high incidence of life threatening maternal and fetal complications. PCI is associated with low success rate and high likelihood of complications and CABG surgery is often required. Recurrent ischemic events due to persistent or new SCAD are common during long-term follow up.
Author Disclosures: O. Havakuk: None. U. Elkayam: None.
- © 2016 by American Heart Association, Inc.