Pregnancy-associated arterial dissections: a nationwide cohort study
| Autor: | Eric A. Secemsky, Brett J Carroll, Andrew Dicks, Loryn Feinberg, Marc L. Schermerhorn, Sebastian Beyer, Scott A. Shainker |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Gestational hypertension
medicine.medical_specialty 030204 cardiovascular system & hematology Cohort Studies 03 medical and health sciences 0302 clinical medicine Pre-Eclampsia Pregnancy medicine Humans 030212 general & internal medicine Risk factor Aged Eclampsia Arterial dissection business.industry Obstetrics Dissection Postpartum Period medicine.disease Gestational diabetes Aortic Dissection Female Cardiology and Cardiovascular Medicine business Postpartum period Cohort study |
| Zdroj: | European heart journal. 41(44) |
| ISSN: | 1522-9645 |
| Popis: | Aims Pregnancy is a known risk factor for arterial dissection, which can result in significant morbidity and mortality in the peripartum period. However, little is known about the risk factors, timing, distribution, and outcomes of arterial dissections associated with pregnancy. Methods and results We included all women ≥12 years of age with hospitalizations associated with pregnancy and/or delivery in the Nationwide Readmissions Database between 2010 and 2015. The primary outcome was any dissection during pregnancy, delivery, or the postpartum period (42-days post-delivery). Secondary outcomes included timing of dissection, location of dissection, and in-hospital mortality. Among 18 151 897 pregnant patients, 993 (0.005%) patients were diagnosed with a pregnancy-related dissection. Risk factors included older age (32.8 vs. 28.0 years), multiple gestation (3.6% vs. 1.9%), gestational diabetes (14.3% vs. 0.2%), gestational hypertension (6.0% vs. 0.6%), and pre-eclampsia/eclampsia (2.7% vs. 0.4%), in addition to traditional cardiovascular risk factors. Of the 993 patients with dissection, 150 (15.1%) dissections occurred in the antepartum period, 232 (23.4%) were diagnosed during the admission for delivery, and 611 (61.5%) were diagnosed in the postpartum period. The most common locations for dissections were coronary (38.2%), vertebral (22.9%), aortic (19.8%), and carotid (19.5%). In-hospital mortality was 3.7% among pregnant patients with a dissection vs. Conclusion Arterial dissections occurred in 5.5/100 000 hospitalized pregnant or postpartum women, most frequently in the postpartum period, and were associated with high mortality risk. The coronary arteries were most commonly involved. Pregnancy-related dissections were associated with traditional risk factors, as well as pregnancy-specific conditions. |
| Databáze: | OpenAIRE |
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