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Pregnancy-associated spontaneous coronary artery dissection: impact of medical treatment. Case report and systematic review.
MedLine Citation:
PMID:  16382385     Owner:  NLM     Status:  MEDLINE    
We report on a 22- year-old woman with postpartum dissection of the left anterior descending artery and the intermediate branch. The patient was treated with acetylsalicylic acid (ASA), clopidogrel, and betablocker only. Coronary angiography performed 20 months later revealed complete resolution of the dissection sites. The patient's cardiovascular risk factors included mild smoking and high total cholesterol and low-density-lipoprotein-cholesterol levels, which showed a marked fall after pregnancy without pharmacological cholesterol-modifying therapy raising the question whether pregnancy-related hypercholesterolemia contributed to the pathogenesis of pregnancy-associated spontaneous coronary artery dissection (P-SCAD). In a systematic review of the literature, 16 women [median age 34 (31-36.5) years] with P-SCAD and angiographic follow-up were identified. The majority (69%) of P-SCAD cases occurred postpartum [median time after delivery: 13 (7-21) days]. In 10/16 (63%) patients medical treatment including betablocker and antiplatelet therapy was given leading to complete resolution of the dissection in 5 of them (31% of all patients) at follow-up, whereas in the other 5 patients the dissections were persisting or even progressive. Of the medically treated patients, 80% were free of symptoms suggestive for ischemia at follow-up. In 5/16 patients percutaneous coronary intervention (PCI) was performed as first-line therapy. Three patients underwent coronary artery bypass grafting, which was performed primarily in one patient, and secondarily in two patients with persisting dissections and ongoing ischemic symptoms after previous medical treatment or PCI without stenting, respectively. In conclusion, medical treatment including ASA, clopidogrel and betablocker therapy results in an excellent clinical and angiographic result in approximately one third of patients with P-SCAD.
M Maeder; P Ammann; G Drack; H Rickli
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Zeitschrift für Kardiologie     Volume:  94     ISSN:  0300-5860     ISO Abbreviation:  Z Kardiol     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-29     Completed Date:  2006-03-31     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  0360430     Medline TA:  Z Kardiol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  829-35     Citation Subset:  IM    
Department Innere Medizin, Fachbereich Kardiologie, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
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MeSH Terms
Aneurysm, Dissecting / diagnosis*,  therapy*
Coronary Aneurysm / diagnosis*,  therapy*
Physician's Practice Patterns
Postpartum Period
Practice Guidelines as Topic
Pregnancy Complications, Cardiovascular / diagnosis*,  therapy*

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