Key result
Pregnancy-associated SCAD is linked to ~3x higher STEMI rates and less LVEF recovery versus non-pregnancy cases.
Why the study?
Spontaneous coronary artery dissection predominantly affects women, but there is a paucity of reproductive health data surrounding pregnancy-associated SCAD.
Do clinical characteristics and SCAD phenotypes differ between women with pregnancy-associated SCAD and non-pregnancy-associated SCAD?
Cohort (n=907)
Yes
Do clinical characteristics and SCAD phenotypes differ between women with pregnancy-associated SCAD and non-pregnancy-associated SCAD?
Absolute Event Rate: 18.6% vs 5.5%
p-value: p=<0.001
Pregnancy-associated SCAD represents a higher-risk phenotype with more severe presentations (STEMI, multivessel involvement, lower LVEF) and less LVEF recovery compared to non-pregnancy-associated SCAD.
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our study builds on prior data that women with P-SCAD often have more severe presentation. Despite this, there were no differences in approach to treatment, with both groups receiving predominantly conservative treatment.”
“The study highlights the importance of hormonal shifts not only during pregnancy or immediately postpartum but up to a year as the woman's body is undergoing significant changes and adjusting to new stresses including breast feeding, contraception, and family dynamics.”
“SCAD affects the same heart artery vessels that atherosclerotic plaque would but instead of it being plaque, it is a spontaneous tearing of the walls of the blood vessel apart from each other. So it is the tearing of the vessel that actually occurs within the layers of the vessel wall itself.”
Closer LVEF monitoring warranted in pregnancy-associated SCAD; reinforces prior severe-phenotype data yet leaves management strategy open.
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 < .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.
Koczo et al. (2026) conducted a cohort in Spontaneous coronary artery dissection (SCAD) (n=907). Pregnancy-associated SCAD vs. Non-pregnancy-associated SCAD was evaluated on Incidence of STEMI (p=<0.001). Women with pregnancy-associated SCAD had a more severe phenotype, including higher STEMI incidence (18.6% vs 5.5%; P<0.001) and less LVEF recovery, compared to non-pregnancy-associated SCAD.
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