Spontaneous peripartum coronary artery dissection presentation and outcome

Abstract

Objective: The objective of this study was to determine whether spontaneous peripartum coronary artery dissection (SPCAD) is a cause of acute myocardial infarction in women. Methods: Patients with SPCAD reported in the recent literature were analyzed to elucidate the clinically relevant characteristics of this condition. Results: Forty-seven cases of SPCAD are described. Patient characteristics include the following: mean age, 33.5 ± 5.2 years; gravity, 2.7 (95% confidence interval, 1.8-3.5); mean gestational age if prepartum, 32.5 ± 4.2 weeks (range, 23-36 weeks); and mean onset if postpartum, 22.9 ± 26.1 days (range, 3-90 days). Only 17 patients (36%) reported a cardiac risk factor, with the most frequent being smoking. All presented with characteristic ischemic pain; 25% of patients were hemodynamically unstable; and 81% of initial electrocardiograms demonstrated ST-elevation myocardial infarctions. The left coronary artery system was involved 81% of the time. Thirty percent of patients were managed conservatively or with thrombolytic therapy, whereas 34% received emergent percutaneous cardiac intervention and 36% required bypass surgery. There were no maternal deaths. Long-term follow-up revealed good cardiac function in the majority of patients, although 3 women required heart transplantation. Conclusions: SPCAD can occur weeks before or after delivery and should be considered in women presenting during the peripartum period with acute chest pain.