RESUMO
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.
Assuntos
Infarto Miocárdico de Parede Anterior , Anomalias dos Vasos Coronários , Complicações Cardiovasculares na Gravidez , Infarto do Miocárdio com Supradesnível do Segmento ST , Doenças Vasculares/congênito , Adulto , Infarto Miocárdico de Parede Anterior/diagnóstico , Infarto Miocárdico de Parede Anterior/mortalidade , Infarto Miocárdico de Parede Anterior/fisiopatologia , Infarto Miocárdico de Parede Anterior/terapia , Ponte de Artéria Coronária , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/mortalidade , Anomalias dos Vasos Coronários/fisiopatologia , Anomalias dos Vasos Coronários/terapia , Feminino , Transplante de Coração , Coração Auxiliar , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/mortalidade , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/terapia , Resultado da Gravidez , Recidiva , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Resultado do Tratamento , Doenças Vasculares/diagnóstico , Doenças Vasculares/mortalidade , Doenças Vasculares/fisiopatologia , Doenças Vasculares/terapia , Função Ventricular Esquerda , Adulto JovemAssuntos
Acidose/terapia , Compostos de Alumínio/intoxicação , Oxigenação por Membrana Extracorpórea/métodos , Hipotensão/terapia , Fosfinas/intoxicação , Suicídio , Disfunção Ventricular Esquerda/terapia , Acidose/induzido quimicamente , Acidose/mortalidade , Doença Aguda , Feminino , Saúde Global , Humanos , Hipotensão/induzido quimicamente , Hipotensão/mortalidade , Masculino , Praguicidas/intoxicação , Taxa de Sobrevida/tendências , Disfunção Ventricular Esquerda/induzido quimicamente , Disfunção Ventricular Esquerda/mortalidade , Poluentes Químicos da Água , Adulto JovemRESUMO
Regadenoson is a pharmacologic stress agent that has been widely adopted as an alternative over other pharmacologic vasodilator agents due to its ease of use, patient tolerance, and safety profile. We report the case of dynamic ST-segment elevation electrocardiogram changes after regadenoson injection during an inpatient single-photon emission computed tomography myocardial perfusion stress test, with subsequent coronary angiography revealing the presence of hemodynamically significant coronary artery disease. Our findings confirm that transient regadenoson-induced ST-segment elevations are a marker for hemodynamically significant disease even in the setting of low-risk SPECT perfusion images.