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, Chayakrit Krittanawong Cardiology Division, New York University Langone Health and New York University School of Medicine , New York, NY 10016 , USA Corresponding author. Tel: + 6469297875, Email: chayakrit.krittanawong@va.gov Search for other works by this author on: Oxford Academic Neelkumar Patel Department of Cardiology, Maimonides Medical Center , Brooklyn, NY 11219 , USA Search for other works by this author on: Oxford Academic Dhrubajyoti Bandyopadhyay Department of Cardiovacular Imaging, Massachusetts General Hospital, Harvard Medical School , Boston, MA 02114 , USA Search for other works by this author on: Oxford Academic Neil Sagar Maitra Division of Cardiology, Scripps Clinic , La Jolla, CA 92121 , USA Search for other works by this author on: Oxford Academic Muzamil Khawaja Department of Cardiology, Emory University School of Medicine , Atlanta, GA 30322 , USA Search for other works by this author on: Oxford Academic Zhen Wang Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, MN 55905 , USA Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic , Rochester, MN 55905 , USA Search for other works by this author on: Oxford Academic Mahboob Alam The Texas Heart Institute, Baylor College of Medicine , Houston, TX 77030 , USA Search for other works by this author on: Oxford Academic Jacob Shani Department of Cardiology, Maimonides Medical Center , Brooklyn, NY 11219 , USA Search for other works by this author on: Oxford Academic Robert Frankel Department of Cardiology, Maimonides Medical Center , Brooklyn, NY 11219 , USA Search for other works by this author on: Oxford Academic Samin Sharma Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital , New York, NY 10029 , USA Search for other works by this author on: Oxford Academic
https://orcid.org/0009-0000-6895-8459 Hani Jneid John Sealy Distinguished Centennial Chair in Cardiology, Chief, Division of Cardiology, University of Texas Medical Branch , Houston, TX 77030 , USA Search for other works by this author on: Oxford Academic
European Heart Journal. Acute Cardiovascular Care, Volume 13, Issue 5, May 2024, Pages 423–428, https://doi.org/10.1093/ehjacc/zuae042
Published:
17 April 2024
Article history
Received:
29 January 2024
Revision received:
04 March 2024
Accepted:
06 March 2024
Published:
17 April 2024
Corrected and typeset:
29 April 2024
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Chayakrit Krittanawong, Neelkumar Patel, Dhrubajyoti Bandyopadhyay, Neil Sagar Maitra, Muzamil Khawaja, Zhen Wang, Mahboob Alam, Jacob Shani, Robert Frankel, Samin Sharma, Hani Jneid, Spontaneous coronary artery dissection outcomes among pregnant vs. non-pregnant women, European Heart Journal. Acute Cardiovascular Care, Volume 13, Issue 5, May 2024, Pages 423–428, https://doi.org/10.1093/ehjacc/zuae042
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Abstract
Aims
Spontaneous coronary artery dissection (SCAD) has become increasingly recognized. It accounts for <1-4% of acute coronary syndrome presentations. Overall, however, it makes up over 40% of pregnancy-associated myocardial infarction. Furthermore, pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is described to have a greater degree of clinical manifestations, including left ventricular dysfunction, shock, and left main or multivessel involvement. The findings are disconcerting, though many studies evaluating P-SCAD are based on case series data or are single centre studies.
Methods and results
The aim of this study was to evaluate a larger national dataset to evaluate the outcomes of SCAD and specifically P-SCAD in an attempt to better characterize the severity and clinical nature of this condition. To conduct this study, we analysed the National Readmission Database from January 2016 to December 2020. Propensity matching was done using the Greedy 1:1 method. Multivariate logistics and time-to-event Cox regression analysis models were built by including all confounders significantly associated with the outcome on univariable analysis with a cut-off P-value of 0.2. In multivariate regression analysis, P-SCAD patients had a non-propensity matched odds ratio (OR) of 0.21 (0.3-1.54, P = 0.123) of dying and a propensity matched OR of 0.11 (0.02-0.61, P = 0.012) of dying. Thirty-day readmission rate for P-SCAD was 15.8% (n = 93) and for non-pregnant spontaneous coronary artery dissection (NP-SCAD) was 11.2% (n = 2286); non-propensity matched OR for readmission for PSCAD patients was 1.68 (1.24-2.29, P = 0.001) and propensity matched OR was 3.39 (1.93-5.97, P < 0.001).
Conclusion
Among hospitalized patient, P–SCAD was associated with similar clinical outcomes and reduced incidence of death when compared with NP–SCAD, though had higher rates of 30–day readmission. Larger–scale observational data will be needed to ascertain the true incidence of cardiovascular complications as it relates to P–SCAD.
Spontaneous coronary artery dissection, Pregnancy
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)
Topic:
- pregnancy
- patient readmission
- spontaneous coronary artery dissection
Issue Section:
Original Scientific Paper > Comorbid Conditions
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