Abstract 18913: Spontaneous Coronary Artery Dissection in Women and Association With Hormonal Stressors

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is an infrequent but important cause of myocardial infarction (MI) in women. Chronic exposure to hormonal therapy, fluctuation in hormonal levels, and a history of multiple pregnancies had been postulated to predispose to SCAD. However, these were not well described in the literature. Methods: Women with SCAD who have consented and are prospectively followed in our Vancouver General Hospital SCAD registries are included in this study. Their background hormonal exposure, pregnancy, and gynaecological histories were extracted from questionnaires, clinical histories, and medical records. These were correlated to in-hospital and long-term outcomes. Results: We included 187 women with SCAD, with mean age 52.6 ± 8.7 years. The majority were Caucasian (83.4%) and 74.0% had fibromuscular dysplasia. All patients presented with MI. Mean number of pregnancy in this cohort was 2.5, with 45 (24.1%) and 25 (13.4%) having ≥4 and ≥5 pregnancies, respectively. Mean number of live births (parity) was 1.8, with 52 (27.8%) having ≥3 births, and 16 (8.6%) having ≥4 births. There were 3 post-partum SCAD (<1 year) and they were still breastfeeding. In terms of hormonal therapy, 28 (15.0%) were actively on hormonal therapy; 5 (2.7%) had prior fertility treatment, 51 (27.3%) had hormone replacement therapy (HRT), 76 (40.6%) had oral contraception, and 36 (19.3%) had gynaecological procedures. There were 107 (57.2%) post-menopausal women, and 23 (12.3%) were peri-menopausal at presentation. There was no death during acute SCAD admission, but 3 died at follow-up (mean 4.1 ± 3.9yrs), and 36 (19.3%) had recurrent SCAD. Patients actively on hormones had higher rate of recurrent SCAD (32.1% vs. 15.8%, p=0.039). There was a higher recurrent MI rate in premenopausal women during index admission (8.9% vs. 1.9%, p=0.037). There was no significant difference in in-hospital and follow-up events in women with past hormonal therapy, post-partum women, or those with parity ≥4 or gravida ≥5. Conclusion: Significant proportion of women with SCAD had exposure to hormonal therapy or had multiple pregnancies/births. Patients actively on hormonal therapy appeared to have higher recurrent SCAD events at follow-up.