title: Spontaneous peripartum coronary artery dissection presentation and outcome.
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.
authors.affiliation: Department of Emergency Medicine, Maine Medical Center, Portland, ME 04102, USA. higgig@mmc.org
authors.forename: George L
authors.initials: GL
authors.lastname: Higgins
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Borofsky
authors.forename: Christine B
authors.initials: CB
authors.lastname: Irish
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Cochran
authors.forename: Tania D
authors.initials: TD
authors.lastname: Strout
mesh_terms: D000328:Adult; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003330:Coronary Vessel Anomalies / Q000175:diagnosis / Q000628:therapy; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011644:Puerperal Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D014652:Vascular Diseases / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy