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Intracoronary Stenting for Postpartum Coronary Artery Dissection
- Miguel Carrascosa Porras, MD;
- Miguel Ares Ares, MD; and
- Javier Zucco Gill, MD
- Hospital of Laredo; 39770 Laredo, Cantabria, Spain Marques Valdecilla University Hospital; 39008 Santander, Cantabria, Spain
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TO THE EDITOR:
Spontaneous coronary artery dissection is a rare and often fatal cause of ischemic heart disease occurring predominantly in young or middle-aged, otherwise healthy patients. The cause of and the optimal management approach for this challenging condition are still being debated [1-4]. To our knowledge, about 200 cases of spontaneous coronary artery dissection have been reported in the world literature. Sixty-eight percent of the reported cases occurred in women, and 30% of these patients were peripartum or puerperal. We describe the second case of postpartum coronary dissection successfully treated by intracoronary stenting; the first case was recently reported elsewhere [2].
A 31-year-old woman was admitted with a diagnosis of acute anterior myocardial infarction 4 days after an uncomplicated spontaneous vaginal delivery. She was a heavy smoker. Because her symptoms had started more than 18 hours before admission, thrombolytic therapy was avoided. The patient was given aspirin and intravenous nitroglycerin, metoprolol, and heparin. When she was discharged 6 days later, she was asymptomatic. However, she later developed recurrent, atypical angina pectoris, and cardiac catheterization was done. Coronary angiography revealed a longitudinal dissection of the proximal left anterior descending artery (Figure 1). Subsequently, an intracoronary stent was successfully implanted, and the patient's condition stabilized. The patient was discharged and continued to receive aspirin and ticlopidine. At a follow-up visit 5 months after stenting, the patient remained asymptomatic.
Physicians must maintain a high index of suspicion for ischemic heart disease when evaluating peripartum or puerperal women with acute chest pain. Confirmation of acute myocardial infarction in this setting should prompt a diligent search for a possible coronary dissection. In the absence of severe left ventricular impairment, symptomatic patients with single-vessel dissection not involving the left main coronary artery could benefit from primary coronary stenting to decrease the chance of sudden death, reinfarction, and arrhythmia.
Miguel Carrascosa Porras, MD
Miguel Ares Ares, MD
Hospital of Laredo; 39770 Laredo, Cantabria, Spain
Javier Zucco Gill, MD
Marques Valdecilla University Hospital; 39008 Santander, Cantabria, Spain
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
