Pregnancy-Associated Spontaneous Coronary Artery Dissection in Women: A Literature Review

Abstract

Spontaneous coronary artery dissection (SCAD) primarily affects women younger than age 50 years, is often misdiagnosed or undiagnosed, and research on this topic is limited. A literature review was conducted to identify unique factors that can facilitate pregnancy-related SCAD (P-SCAD) diagnosis as well as differentiate it from nonpregnancy-related SCAD (NP-SCAD). A literature search was conducted on PubMed, Medline, Embase, The Cochrane Database of Systematic Reviews, and Google Scholar databases that focused on NP-SCAD and P-SCAD cases reported in North America between 2006 and 2021 using the terms spontaneous coronary artery dissection, misdiagnosis, and women, along with postpartum and pregnancy. The Let Evidence Guide Every New Decision quality assessment tool was applied to all reviews. A total of 108 journal articles reporting on individual cases, case series examining independent SCAD registries, as well as literature reviews were identified. These included 1547 SCAD cases in women, 510 of which were identified as P-SCAD. SCAD occurs predominantly in women, and thus presents a diagnostic challenge because women are not typically considered at risk for developing cardiovascular diseases and may present with symptoms that mimic other medical conditions. This issue is further exacerbated when SCAD develops during pregnancy or the postpartum period (ie, P-SCAD to differentiate it from SCAD occurring in other periods of woman's life such as NP-SCAD) because P-SCAD patients often present with less typical cardiac symptoms yet tend to experience more severe illness that can jeopardize their health and that of their baby. P-SCAD was associated with higher ST-segment elevation myocardial infarction rates, higher troponin levels, and a greater risk of cardiogenic shock compared with NP-SCAD cohorts. It was also evident that the failure rates associated with invasive procedures such as percutaneous coronary intervention and coronary artery bypass graft surgery were higher in P-SCAD patients, whereas the mortality rates are comparable to NP-SCAD cohorts if diagnosed and treated appropriately. Because younger women are rarely screened, they are at greater risk from SCAD, especially if this condition develops during pregnancy or ≤30 days following delivery. It is essential that medical professionals providing care for pregnant women understand P-SCAD risk factors and provide medical counseling for pregnant women or those planning a pregnancy to be better equipped to recognize its more subtle signs and symptoms, thus facilitating timely specialist referral, diagnosis, and treatment. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX).