title: Pregnancy and the Risk of Spontaneous Coronary Artery Dissection: An Analysis of 120 Contemporary Cases.
abstract: BACKGROUND
  Because of the rarity of this condition, information on pregnancy-associated spontaneous coronary artery dissection is limited. We reviewed a large number of contemporary pregnancy-associated spontaneous coronary artery dissection cases in an attempt to define the clinical characteristics and provide management recommendations.
  
  
  RESULTS
  A literature search for cases of pregnancy-associated spontaneous coronary artery dissection reported between 2000 and 2015 included 120 cases; 75% presented with ST-segment-elevation myocardial infarction, and 80% had anterior myocardial infarction. Left anterior descending coronary artery was involved in 72% of cases, left main segment in 36%, and 40% had multivessel spontaneous coronary artery dissection. Ejection fraction was reduced to <40% in 44% of cases. Percutaneous coronary intervention was successful in only 50% of cases. Coronary artery bypass surgery was performed in 44 cases because of complex anatomy, hemodynamic instability, or failed percutaneous coronary intervention. Maternal complications included cardiogenic shock (24%), mechanical support (28%), urgent percutaneous coronary intervention (28%), urgent coronary artery bypass surgery (27.5%), maternal mortality (4%), and fetal mortality (2.5%). During follow-up for 305±111 days, there was a high incidence of symptoms because of persistent or new spontaneous coronary artery dissections, and 5 women needed heart transplantation or ventricular assist device implantation.
  
  
  CONCLUSIONS
  Pregnancy-associated spontaneous coronary artery dissection is commonly associated with left anterior descending, left main, and multivessel involvement, which leads to a high incidence of reduced ejection fraction, and life-threatening maternal and fetal complications. Percutaneous coronary intervention is associated with low success rate and high likelihood of complications, and coronary artery bypass surgery is often required. Recurrent ischemic events because of persistent or new spontaneous coronary artery dissection are common during long-term follow-up.
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles.
authors.forename: Ofer
authors.initials: O
authors.lastname: Havakuk
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles.
authors.forename: Sorel
authors.initials: S
authors.lastname: Goland
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles.
authors.forename: Anil
authors.initials: A
authors.lastname: Mehra
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles. elkayam@usc.edu.
authors.forename: Uri
authors.initials: U
authors.lastname: Elkayam
mesh_terms: D000328:Adult; D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D001026:Coronary Artery Bypass; D003330:Coronary Vessel Anomalies / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011256:Pregnancy Outcome; D012008:Recurrence; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000151:congenital* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left; D055815:Young Adult
keywords: acute coronary syndrome; angiography; myocardial infarction; percutaneous coronary intervention; preeclampsia; pregnancy