A nationwide evaluation of spontaneous coronary artery dissection in pregnancy and the puerperium

Autor: Natalie Bottega, Alice Benjamin, Richard Brown, Majed S. Faden
Rok vydání: 2016
Předmět:
Adult
medicine.medical_specialty
Databases
Factual
Coronary Vessel Anomalies
Pregnancy Complications
Cardiovascular
Population
Myocardial Infarction
030204 cardiovascular system & hematology
Chest pain
Risk Assessment
Young Adult
03 medical and health sciences
0302 clinical medicine
Pregnancy
Risk Factors
Odds Ratio
Prevalence
medicine
Humans
Vascular Diseases
030212 general & internal medicine
Myocardial infarction
Coronary Artery Bypass
Healthcare Cost and Utilization Project
education
education.field_of_study
Chi-Square Distribution
Obstetrics
business.industry
Angioplasty
Postpartum Period
Odds ratio
Length of Stay
Middle Aged
medicine.disease
United States
Surgery
Logistic Models
Treatment Outcome
Female
Stents
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Scad
Postpartum period
Cohort study
Zdroj: Heart. 102:1974-1979
ISSN: 1468-201X
1355-6037
Popis: Objective Spontaneous coronary artery dissection (SCAD) is a rare and potentially lethal cause of myocardial infarction (MI). The purpose of our study was to estimate the prevalence and maternal outcomes of pregnancies complicated by SCAD. Materials and methods A population-based cohort study on all births identified in the Healthcare Cost and Utilization Project from 2008 to 2012. Disease prevalence was calculated and logistic regression was used to estimate the adjusted odds ratio (aOR) for risk factors and different maternal complications. Results A total of 4 363 343 pregnancy-related discharges were evaluated. 79 cases of SCAD were identified resulting in a prevalence of 1.81 per 100 000 pregnancies. The mean maternal age at the time of diagnosis was 33.4 years (±5.2). Chronic hypertension (aOR, 2.67; 95% CI 1.18 to 6.03), lipid profile abnormalities (aOR, 48.22; 95% CI 24.25 to 95.90), chronic depression (aOR, 3.56; 95% CI 1.43 to 8.83) and history of migraine (aOR, 3.93; 95% CI 1.52 to 10.17) were associated with an elevated risk for SCAD. MI was diagnosed in 66 (85.5%) cases of SCAD with anterior and subendocardial territories being the most common locations. Thirty one patients (40%) with SCAD underwent angioplasty with the majority receiving stents, which was associated with a longer hospital stay than those treated conservatively or with bypass. Conclusions SCAD is a rare aetiology of MI; risk factors and outcomes are illustrated in the current study. The puerperium is an important period for the development of pregnancy-related SCAD. Careful evaluation of pregnant and postpartum women with chest pain is warranted, especially if these risk factors are identified.
Databáze: OpenAIRE
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