Abstract 10590: Long-term Outcomes in Patients With Pregnancy Related vs. Non-pregnancy Related Spontaneous Coronary Artery Dissection: An International Multi-center Collaborative Study

BackgroundSpontaneous coronary artery dissection (SCAD) is an acute coronary event associated with significant morbidity and an important cause of pregnancy-related myocardial infarctions (MI).HypothesisThis study aimed to evaluate whether pregnancy-related SCAD (P-SCAD) was associated with more severe presentation and worse outcomes when compared with non-pregnancy related SCAD (NP-SCAD).MethodsA total of 75 P-SCAD women (experiencing SCAD during pregnancy or up to 1 year post-delivery) were identified from 2007 to 2017 and matched with 143 NP-SCAD women by age at first SCAD and geographic region. Clinical presentation, management, in-hospital course, and prognosis were evaluated using medical chart review. All coronary angiograms underwent core lab analysis to assess for the presence of SCAD and its characteristics. SCAD recurrence and major adverse cardiovascular events (MACE - death, MI, revascularization and stroke) were examined using adjusted Cox proportional hazards regression.ResultsMedian age at first SCAD was 36 (34-38) years. P-SCAD patients were more likely than NP-SCAD to have left main or multivessel involvement (20% vs. 8.4%, p=0.01; 44% vs. 27.3%, p=0.01 respectively). Over the follow-up of 2 (0.8 - 3.5) years, recurrent SCAD was present in 28 (13%) participants, and MACE in 37 (17%). We found no evidence that SCAD recurrence or MACE were different between P-SCAD vs. NP-SCAD. Although, right coronary artery (RCA) involvement, optical coherent tomography (OCT) and return to catheterization lab during the index SCAD hospitalization were associated with MACE. RCA involvement was also associated with SCAD recurrence (Figure).ConclusionP-SCAD patients have more severe clinical presentation than NP-SCAD, but with similar outcomes. RCA involvement and acute interventional management appear to be associated with SCAD prognosis. Further research of optimal management strategies in SCAD is warranted to improve patient outcomes.