Title

Spontaneous peripartum coronary artery dissection presentation and outcome.

Document Type

Article

Publication Date

1-1-2013

Institution/Department

Emergency Medicine

Journal Title

J Am Board Fam Med

MeSH Headings

Adult, Coronary Artery Bypass, Coronary Vessel Anomalies, Female, Heart Transplantation, Humans, Myocardial Infarction, Percutaneous Coronary Intervention, Pregnancy, Pregnancy Complications, Cardiovascular, Puerperal Disorders, Thrombolytic Therapy, Vascular Diseases

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.

ISSN

1558-7118

First Page

82

Last Page

89

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