Pregnancy-Associated Spontaneous Coronary Artery Dissection

Importance Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction predominantly affecting women. There is a paucity of reproductive health data surrounding pregnancy-associated SCAD (P-SCAD). Objective To examine detailed reproductive variables as well as demographics, psychosocial, and SCAD-event factors among women with a history of at least 1 prior pregnancy in a large, multicenter registry (iSCAD Registry). Design, Setting, and Participants This cohort study compared data of women with P-SCAD vs women with non–pregnancy-associated SCAD (NP-SCAD) between the years 2019 and 2024 and rates of certain reproductive health features among the general reproductive-aged population in US states. Differences were analyzed using the Kruskal-Wallis test for continuous variables and χ 2 test for categorical variables. Exposures Pregnancy and SCAD. Main Outcomes and Measures Patient survey-based clinical and reproductive history variables were collected and corroborated with investigator-extracted clinical and imaging data, including detailed characterization of the SCAD event. Results Among 907 women (median IQR age at enrollment, 52.0 45.1-59.4 years; median IQR age at first SCAD event, 49.2 42.3-57.1 years) with SCAD and 1 or more pregnancies, 98 had P-SCAD with median (IQR) age of 36.7 (33.7-39.1) years at time of SCAD event. Those with P-SCAD had a lower prevalence of fibromuscular dysplasia (27 of 86 31% vs 309 of 681 45%; P = .01) but similar rates of extracoronary abnormalities. Greater use of assisted reproductive technology (ART; 25 of 97 26% vs 98 of 804 12%), greater multigravida with more than 5 gestations (13 of 98 13% vs 55 of 809 7%), and preeclampsia (24 of 98 25% vs 101 of 809 13%; P = .001) were reported among women with P-SCAD. Those with P-SCAD had a more severe SCAD phenotype including higher incidence of STEMI (16 of 86 18.6% vs 40 of 733 5.5%; P lt; .001), multivessel segment involvement (22 of 70 31% vs 101 of 588 17%; P = .004), and left ventricular ejection fraction (LVEF) lower than 40% (4 of 15 27% vs 6 of 105 7%; P = .006). They also experienced less LVEF recovery by 1-year follow-up. The majority (661 of 887 75%) of both groups were primarily medically managed. Conclusions and Relevance From this large, multisite registry, results reveal that women with P-SCAD had greater median ages at gestation, greater history of ART use, and greater instances of multigravida and preeclampsia than women with NP-SCAD and the general reproductive-aged US population. With high percentages of vascular imaging among participants, women with P-SCAD had less fibromuscular dysplasia but similar rates of extracoronary abnormalities including dissection and aneurysms as women with NP-SCAD. In this contemporary cohort, women with P-SCAD continue to represent a higher-risk phenotype with predominantly conservative management; however, they had less LVEF recovery.