title: Pregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients.
abstract: OBJECTIVE
  We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes.
  
  
  RESULTS
  Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 ± 3.7 years; most patients had no risk factors for coronary artery disease, and the majority were multiparous. P-SCAD occurred during the puerperium in 12 patients with a median time of 10 days. Only one patient presented with P-SCAD in the 37th week of pregnancy, and she was the only patient who died in this series. Six patients (46%) presented with ST-segment elevation acute myocardial infarction (STEMI), six (46%) presented with non-STEMI, and one presented with unstable angina; one-third of women had cardiogenic shock. In 12 patients, the dissection involved the left anterior descending or circumflex artery, and it extended to the left main coronary artery in 6 patients. Intravascular ultrasound or optical coherence tomography helped to confirm diagnosis and guide treatment in 46% of cases. Seven women were managed clinically; percutaneous coronary intervention was performed in five cases, and coronary artery bypass grafting was performed in one patient.
  
  
  CONCLUSIONS
  In these 13 cases of P-SCAD, clinical presentation commonly included acute myocardial infarction and cardiogenic shock. Multivessel dissections and involvement of the left coronary artery and left main coronary artery were highly prevalent. Clinicians must be aware of angiographic appearances of P-SCAD for prompt diagnosis and management in these high-risk patients.
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.|Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Jamil R
authors.initials: JR
authors.lastname: Cade
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.|Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Szarf
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.|Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Maria Eduarda M
authors.initials: ME
authors.lastname: de Siqueira
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: Áurea
authors.initials: Á
authors.lastname: Chaves
authors.affiliation: Clínica São Vicente, Rio de Janeiro, Brazil.
authors.forename: Júlio C M
authors.initials: JC
authors.lastname: Andréa
authors.affiliation: Clínica São Vicente, Rio de Janeiro, Brazil.
authors.forename: Hélio R
authors.initials: HR
authors.lastname: Figueira
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Manuel M
authors.initials: MM
authors.lastname: Gomes
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Bárbara P
authors.initials: BP
authors.lastname: Freitas
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Filgueiras Medeiros
authors.affiliation: Santa Casa de Misericórdia de Goiânia, Goiás, Brazil.
authors.forename: Márcio Ricardo
authors.initials: MR
authors.lastname: Dos Santos
authors.affiliation: Santa Casa de Misericórdia de Goiânia, Goiás, Brazil.
authors.forename: Walter B
authors.initials: WB
authors.lastname: Fiorotto
authors.affiliation: Hospital Regional de Mato Grosso do Sul, Mato Grosso do Sul, Brazil.
authors.forename: Augusto
authors.initials: A
authors.lastname: Daige
authors.affiliation: Hospital Bandeirantes, São Paulo, Brazil.
authors.forename: Rosaly
authors.initials: R
authors.lastname: Gonçalves
authors.affiliation: Hospital Bandeirantes, São Paulo, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cantarelli
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Cláudia Maria Rodrigues
authors.initials: CM
authors.lastname: Alves
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.|Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Leandro
authors.initials: L
authors.lastname: Echenique
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Fábio S
authors.initials: FS
authors.lastname: de Brito
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Perin
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.|Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Born
authors.affiliation: Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Harvey
authors.initials: H
authors.lastname: Hecht
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil adriano.caixeta@einstein.br.|Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
mesh_terms: D000328:Adult; D000072226:Computed Tomography Angiography / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D064847:Multimodal Imaging / Q000379:methods*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000628:therapy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D062606:Tertiary Care Centers; D018084:Ultrasonography, Interventional / Q000379:methods; D014652:Vascular Diseases / Q000151:congenital* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy
keywords: acute myocardial infarction; intravascular ultrasound; optical coherence tomography; peripartum; spontaneous coronary artery dissection