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Civieri G, Vadori M, Masiero G, Iop L, Tansella D, Pergola V, Cozzi E, Iliceto S, Tona F. Spontaneous coronary artery dissection in women with acute myocardial infarction: is there a new role for autoimmunity? EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:856-861. [PMID: 37389577 DOI: 10.1093/ehjacc/zuad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction in women and has an unclear pathophysiology. Autoantibodies (AAs) targeting angiotensin-II receptor type 1 (AT1R) and endothelin-1 receptor type A (ETAR) have known detrimental effects on endothelial function. We investigated the prevalence of these AAs in SCAD-affected female patients. METHODS AND RESULTS Female patients diagnosed at coronary angiography with myocardial infarction and SCAD were consecutively enrolled. Autoantibodies targeting angiotensin-II receptor type 1 and ETAR-AA titres and seropositivity prevalence were compared between SCAD patients, ST-elevation myocardial infarction (STEMI) patients, and healthy women. Ten women with SCAD and 20 age-matched controls (10 women with STEMI and 10 healthy women) were included. Six out of 10 (60%) women with myocardial infarction and SCAD were seropositive for AT1R-AAs and ETAR-AAs. In contrast, only one (10%) healthy woman and one (10%) STEMI patient were seropositive for AT1R-AAs (P = 0.03 and P = 0.03, respectively). One STEMI patient was seropositive for ETAR-AAs, while none of the healthy women was found to be seropositive (P = 0.03 and P = 0.01, respectively). The median AA titre was significantly higher in SCAD patients than in healthy women (P = 0.01 for AT1R-AAs; P = 0.02 for ETAR-AAs) and STEMI patients (P < 0.001 for AT1R-AAs; P = 0.002 for ETAR-AAs). CONCLUSION Autoantibodies targeting angiotensin-II receptor type 1 and ETAR-AA seropositivity is significantly higher in SCAD women with myocardial infarction than in healthy women or female patients with STEMI. Our findings, corroborated by previous data in the literature and biological plausibility, suggest a possible role for AT1R-AAs and ETAR-AAs in the pathophysiology of SCAD in women with acute myocardial infarction and should warrant further studies with larger sample sizes.
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Affiliation(s)
- Giovanni Civieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Marta Vadori
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Laura Iop
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Donatella Tansella
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Emanuele Cozzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Francesco Tona
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
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Paratz ED, Kao C, MacIsaac AI, Somaratne J, Whitbourn R. Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2018; 18:1-6. [PMID: 29750179 PMCID: PMC5941240 DOI: 10.1016/j.ijcha.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 12/13/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is defined as SCAD occurring during pregnancy or within 3 months post-partum. Earlier systematic reviews have suggested a high maternal and foetal mortality rate. We undertook a structured systematic review of P-SCAD demographics, management and maternal and foetal outcomes. METHODS Case study identification was conducted according to PRISMA guidelines, with screening of all published P-SCAD cases not meeting pre-defined exclusion criteria. Of two hundred and seventy-three publications screened, one hundred and thirty-eight cases met inclusion criteria. Cases were allocated to one of three time periods; 1960-85 (twenty cases) reflecting early management of P-SCAD, 1986-2005 (forty-two cases) reflecting recent management, and 2006-16 (seventy-six cases), reflecting contemporary management. RESULTS The only significant demographic change in women experiencing P-SCAD over the last 50 years was an increasing proportion of primigravidas (p = 0.02). Management and outcomes, however, have altered significantly. Emergent angiography (p < 0.0001), reduced thrombolysis (p = 0.006) and increasingly conservative or percutaneous management (p < 0.0001) are associated with dramatic reductions in maternal mortality (85% in earliest reports to 4% in the last decade, p < 0.0001) and foetal mortality (50% in earliest reports to 0.0% in the last decade, p = 0.023). CONCLUSION This systematic review of temporal changes in presentation, management and outcomes of P-SCAD represents the widest range of variables analysed in the largest cohort of P-SCAD patients to date. In the setting of earlier coronary angiography and increasingly conservative management, maternal and foetal survival rates continue to improve.
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Affiliation(s)
| | - Chien Kao
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | | | - Robert Whitbourn
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
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Havakuk O, Goland S, Mehra A, Elkayam U. Pregnancy and the Risk of Spontaneous Coronary Artery Dissection: An Analysis of 120 Contemporary Cases. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.004941. [PMID: 28302642 DOI: 10.1161/circinterventions.117.004941] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because of the rarity of this condition, information on pregnancy-associated spontaneous coronary artery dissection is limited. We reviewed a large number of contemporary pregnancy-associated spontaneous coronary artery dissection cases in an attempt to define the clinical characteristics and provide management recommendations. METHODS AND RESULTS A literature search for cases of pregnancy-associated spontaneous coronary artery dissection reported between 2000 and 2015 included 120 cases; 75% presented with ST-segment-elevation myocardial infarction, and 80% had anterior myocardial infarction. Left anterior descending coronary artery was involved in 72% of cases, left main segment in 36%, and 40% had multivessel spontaneous coronary artery dissection. Ejection fraction was reduced to <40% in 44% of cases. Percutaneous coronary intervention was successful in only 50% of cases. Coronary artery bypass surgery was performed in 44 cases because of complex anatomy, hemodynamic instability, or failed percutaneous coronary intervention. Maternal complications included cardiogenic shock (24%), mechanical support (28%), urgent percutaneous coronary intervention (28%), urgent coronary artery bypass surgery (27.5%), maternal mortality (4%), and fetal mortality (2.5%). During follow-up for 305±111 days, there was a high incidence of symptoms because of persistent or new spontaneous coronary artery dissections, and 5 women needed heart transplantation or ventricular assist device implantation. CONCLUSIONS Pregnancy-associated spontaneous coronary artery dissection is commonly associated with left anterior descending, left main, and multivessel involvement, which leads to a high incidence of reduced ejection fraction, and life-threatening maternal and fetal complications. Percutaneous coronary intervention is associated with low success rate and high likelihood of complications, and coronary artery bypass surgery is often required. Recurrent ischemic events because of persistent or new spontaneous coronary artery dissection are common during long-term follow-up.
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Affiliation(s)
- Ofer Havakuk
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Sorel Goland
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Anil Mehra
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Uri Elkayam
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles.
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Adler C, Jesus J, Reuter H. [Acute dyspnea 8 days after Cesarean section]. Med Klin Intensivmed Notfmed 2015; 111:544-6. [PMID: 26440100 DOI: 10.1007/s00063-015-0090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/19/2015] [Accepted: 08/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- C Adler
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - J Jesus
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - H Reuter
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Dubbs SB, Tewelde SZ. Cardiovascular Catastrophes in the Obstetric Population. Emerg Med Clin North Am 2015; 33:483-500. [DOI: 10.1016/j.emc.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ashikaga K, Mizuno K, Yoneyama K, Mitarai T, Koyama K, Tanabe Y, Kongoji K, Harada T, Akashi YJ. Spontaneous healing of spontaneous coronary artery dissection after balloon angioplasty: Follow-up for over 9 months using optical coherence tomography and intravascular ultrasound. Int J Cardiol 2015; 191:167-9. [PMID: 25965625 DOI: 10.1016/j.ijcard.2015.04.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 04/30/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Kohei Ashikaga
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan; Division of Cardiology, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Koichi Mizuno
- Division of Cardiology, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Kihei Yoneyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takanobu Mitarai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Koyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ken Kongoji
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
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