NEW ORLEANS – Women with pregnancy-related spontaneous coronary artery dissection (P-SCAD) had a more severe presentation than women with SCAD who were not pregnant (NP-SCAD), according to a cohort study.
Based on prospectively collected data from iSCAD RegistryThose with P-SCAD had lower rates of fibromuscular dysplasia than women with NP-SCAD (31% vs. 45%, P=0.01) but similar levels of extracoronary abnormalities, Agnes Koczow, MD, of the University of Pittsburgh Medical Center and colleagues reported. The data were presented at the annual meeting of the American College of Cardiology and also published JAMA Cardiology.
Women with P-SCAD have a more severe SCAD phenotype than women with NP-SCAD, including a higher incidence of ST-segment elevation myocardial infarction (STEMI, 18.6% vs. 5.5%). P<0.001), multivessel segment involvement (31% vs 17%, P=0.004), left ventricular ejection fraction (LVEF) less than 40% (27% vs 7%, P=0.006), and in-hospital major adverse cardiovascular events (10% vs. 5%, P=0.03). Also, those with p-SCAD experienced less LVEF recovery at 1-year follow-up, with recovery defined as LVEF ≥50% on follow-up echocardiogram within 1 year of follow-up, the authors said.
Three-quarters of both groups were managed primarily medically and did not undergo percutaneous coronary intervention (PCI). The authors reported that the proportion of people with P-SCAD who received anticoagulation in the hospital was significantly lower than that of NP-SCAD (74% vs. 87%). P=0.001), but rates of in-hospital use of single and dual antiplatelet therapy were similar in both groups.
Of the approximately one-quarter of people who underwent PCI, “there were no PCI-related complications in the group with p-SCAD (vessel perforation, side branch loss, no-reflow, sudden vessel closure, thrombus formation, SCAD extension, or edge dissection),” Koczow’s group said.
“Our study builds on prior data that women with P-SCAD often have a more severe presentation,” Koczow said. Medpage Today. “Despite this, there was no difference in treatment approach, with both groups receiving mainly conservative treatment.”
The authors noted that p-SCAD, a cause of nonatherosclerotic MI, “is a highly morbidity condition for which there are limited data to guide pregnancy counseling.”
The analysis found that women with P-SCAD were also significantly more likely to use assisted reproductive technology (ART, 26% vs. 12% in the NP-SCAD group). P<0.001), having pre-eclampsia (25% vs 13%, P=0.001), and being pregnant with more than five pregnancies (13% vs. 7%), P=0.02).
Miriam Tarsa, MD, MAS, of the University of California, San Diego, said that p-SCAD is poorly understood and that research is desperately needed, particularly on the risk of devastating cardiovascular events during pregnancy and the postpartum period. Tarsa said she appreciated that the P-SCAD group in this study included women up to a year postpartum.
“The study highlights the importance of hormonal changes not only during pregnancy or immediately postpartum, but also for up to a year, as a woman’s body is undergoing significant changes and adjusting to new stressors, including breastfeeding, contraception, and family dynamics,” said Tarsa, who was not involved in the study. Medpage Today. He said it also draws attention to the importance of baseline cardiac screening, which should begin before pregnancy, especially for patients interested in ART.
The authors analyzed data from 2019-2024 from a prospective registry, which collects patient-facing survey data and investigator-confirmed clinical and imaging data in the US and Australia. Adult women included in the analysis had a SCAD diagnosis that was not iatrogenic or related to atherosclerosis that was confirmed by coronary angiography; Any history of pregnancy; and answered a baseline questionnaire.
Overall, there were 907 participants (n = 98 with P-SCAD; n = 809 with NP-SCAD) whose mean age at enrollment was 52.0 and at first SCAD program was 49.2. The mean age at first SCAD event was lower in the P-SCAD group than in the NP-SCAD group (36.7 vs. 50.7).
Most of the group was white (87.4%), not Hispanic or Latino (94.9%); 7.8% were Black or African American, 5.1% were Hispanic or Latino, 2.0% were Asian, 1.5% were multiracial, 0.5% were American Indian or Alaska Native, and 0.3% were Native Hawaiian or Other Pacific Islander.
“An important takeaway is that all patients with SCAD, whether pregnancy-associated or not, should have comprehensive vascular imaging given the similar prevalence of vascular abnormalities between the P-SCAD and NP-SCAD groups,” Koczow said.
Limitations of the study included patients’ self-reporting information on reproductive health facilities and mental health surveys, the possibility of missing data, and the acute coronary syndrome classification chosen by the sites. Koczow said his group hopes to continue research into how hormone fluctuations affect SCAD incidence.
