Key result
Pregnancy-associated arterial dissections occur mostly postpartum and are linked to 3.7% in-hospital mortality.
Why the study?
Pregnancy is a recognized risk factor for arterial dissection, but little is known about the risk factors, timing, distribution, and outcomes of pregnancy-associated arterial dissections.
Cohort (n=18,151,897)
Yes
Pregnancy-associated arterial dissections are rare (5.5 per 100,000) but carry a high mortality risk, most frequently occur in the postpartum period, and most commonly involve the coronary arteries.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We always need to remember that these kinds of catastrophic complications can occur. Even though they're rare, we don't want to miss them.”
“As a cardiovascular specialist, I evaluate and manage arterial dissections in the peripartum period so was a bit surprised by how rare these events are. Fortunately the incidence of such events is quite low when reviewed from a population-based level.”
“A clinical implication of this finding is that patients with dissection occurring during pregnancy and labor/delivery should be considered for genetic evaluation. Genetic screening also may be indicated for postpartum dissections. Spontaneous coronary artery dissection (SCAD) was the most common type of dissection in the postpartum period, and it is currently estimated that ~5% of patients with SCAD have an underlying 'monogenic' genetic diagnosis.”
High mortality with rare pregnancy-related dissections warrants postpartum vigilance; leaves open optimal prevention and management strategies.
AIMS: Pregnancy is a known risk factor for arterial dissection, which can result in significant morbidity and mortality in the peripartum period. However, little is known about the risk factors, timing, distribution, and outcomes of arterial dissections associated with pregnancy. METHODS AND RESULTS: We included all women ≥12 years of age with hospitalizations associated with pregnancy and/or delivery in the Nationwide Readmissions Database between 2010 and 2015. The primary outcome was any dissection during pregnancy, delivery, or the postpartum period (42-days post-delivery). Secondary outcomes included timing of dissection, location of dissection, and in-hospital mortality. Among 18 151 897 pregnant patients, 993 (0.005%) patients were diagnosed with a pregnancy-related dissection. Risk factors included older age (32.8 vs. 28.0 years), multiple gestation (3.6% vs. 1.9%), gestational diabetes (14.3% vs. 0.2%), gestational hypertension (6.0% vs. 0.6%), and pre-eclampsia/eclampsia (2.7% vs. 0.4%), in addition to traditional cardiovascular risk factors. Of the 993 patients with dissection, 150 (15.1%) dissections occurred in the antepartum period, 232 (23.4%) were diagnosed during the admission for delivery, and 611 (61.5%) were diagnosed in the postpartum period. The most common locations for dissections were coronary (38.2%), vertebral (22.9%), aortic (19.8%), and carotid (19.5%). In-hospital mortality was 3.7% among pregnant patients with a dissection vs. <0.001% in patients without a dissection. Deaths were isolated to patients with an aortic (8.6%), coronary (4.2%), or supra-aortic (<2.5%) dissection. CONCLUSION: Arterial dissections occurred in 5.5/100 000 hospitalized pregnant or postpartum women, most frequently in the postpartum period, and were associated with high mortality risk. The coronary arteries were most commonly involved. Pregnancy-related dissections were associated with traditional risk factors, as well as pregnancy-specific conditions.
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Beyer et al. (2020) conducted a cohort in Pregnancy-associated arterial dissections (n=18,151,897). Pregnancy was evaluated on Any dissection during pregnancy, delivery, or the postpartum period (42-days post-delivery). Pregnancy-associated arterial dissections occurred in 0.005% of hospitalizations, most frequently postpartum, and carried a 3.7% in-hospital mortality versus <0.001% in those without dissection.
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