Spontaneous Coronary Artery Dissection in Postpartum Women: A Review of Published Cases

Abstract

Background: Spontaneous coronary artery dissection separates the coronary wall without atherosclerosis, and the
pregnancy-associated form affects young women presenting when attention is directed at obstetric rather than coronary
diagnoses.
Objective: To summarise what the published record shows about its timing, phenotype and management, and whether treating it
as atherosclerotic infarction is justified.
Methods: Narrative review of published cohort studies, registries, systematic reviews and individual case reports.
Findings: Across 316 pooled published cases, 249 (79.6%) occurred after delivery. Pregnancy-associated cases presented with ST
elevation more often than non-pregnancy cases, 57% versus 36%. In unselected cohorts not restricted to pregnancy, percutaneous
intervention failed in 53% of 95 revascularisation patients, whereas 85 of 94 managed conservatively had an uneventful course.
Conclusions: The published record supports conservative management wherever flow and haemodynamics allow, with
revascularisation reserved for instability; it does not support routine intervention, and no randomised comparison exists