Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients.

Autor:	Cade JR; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.; Hospital Israelita Albert Einstein, São Paulo, Brazil., Szarf G; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.; Hospital Israelita Albert Einstein, São Paulo, Brazil., de Siqueira ME; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.; Mount Sinai Medical Center, New York, NY, USA., Chaves Á; Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil., Andréa JC; Clínica São Vicente, Rio de Janeiro, Brazil., Figueira HR; Clínica São Vicente, Rio de Janeiro, Brazil., Gomes MM Jr; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil., Freitas BP; Hospital Israelita Albert Einstein, São Paulo, Brazil., Filgueiras Medeiros J; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil., Dos Santos MR; Santa Casa de Misericórdia de Goiânia, Goiás, Brazil., Fiorotto WB; Santa Casa de Misericórdia de Goiânia, Goiás, Brazil., Daige A; Hospital Regional de Mato Grosso do Sul, Mato Grosso do Sul, Brazil., Gonçalves R; Hospital Bandeirantes, São Paulo, Brazil., Cantarelli M; Hospital Bandeirantes, São Paulo, Brazil., Alves CM; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil., Echenique L; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.; Hospital Israelita Albert Einstein, São Paulo, Brazil., de Brito FS Jr; Hospital Israelita Albert Einstein, São Paulo, Brazil., Perin MA; Hospital Israelita Albert Einstein, São Paulo, Brazil., Born D; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.; Hospital Israelita Albert Einstein, São Paulo, Brazil., Hecht H; Mount Sinai Medical Center, New York, NY, USA., Caixeta A; Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil adriano.caixeta@einstein.br.; Hospital Israelita Albert Einstein, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2017 Jan; Vol. 18 (1), pp. 54-61. Date of Electronic Publication: 2016 Feb 28.
DOI:	10.1093/ehjci/jew021
Abstrakt:	Aims: We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. Methods and Results: Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient. Conclusion: In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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