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Canadian Journal of Cardiology

Nonatherosclerotic Coronary Artery Disease in Young Women

Published:January 27, 2014DOI:https://doi.org/10.1016/j.cjca.2014.01.011

      Abstract

      Background

      Nonatherosclerotic coronary artery disease (NACAD) is an important cause of myocardial infarction (MI) in young women but is often missed on coronary angiography, especially spontaneous coronary artery dissection (SCAD). The prevalence of NACAD in young women has not been described.

      Methods

      We retrospectively reviewed all coronary angiograms of women aged 50 years and younger at Vancouver General Hospital from December 1, 2009 to November 30, 2011. The angiograms were reviewed by 2 experienced interventional cardiologists, and reported as normal (<30% stenosis), atherosclerotic coronary artery disease (ACAD), or NACAD. NACAD was further characterized as SCAD, coronary fibromuscular dysplasia (FMD), ectasia, vasculitis, embolism, congenital anomaly, or unclear etiology.

      Results

      Of 7605 coronary angiograms performed, 177 were done in women aged 50 years and younger. The mean age was 45.4 ± 4.9 (range, 31-50) years, 76 of 177 (42.9%) presented with acute coronary syndrome, and 66 were troponin-positive. Ninety-seven (54.8%) women had normal arteries, 54 (30.5%) had ACAD, 23 (13.0%) had NACAD, and 3 (1.7%) had unclear etiology. Of those with NACAD, SCAD was observed in 16 (all troponin-positive and 13 of 16 had noncoronary FMD), and 2 had irregular beading suspicious of coronary FMD. Coronary vasculitis was suspected in 2, and 5 had coronary ectasia. Among women with MI (66/177), 19 (28.8%) had normal arteries (3 Takotsubo cardiomyopathy), 24 (36.4%) had ACAD, 20 (30.3%) had NACAD, 16 (24.2%) had SCAD, and 3 had unclear etiology.

      Conclusions

      NACAD was not rare among young women (aged 50 years and younger) undergoing coronary angiography and was an important cause of MI, accounting for 30%. SCAD was the most commonly encountered NACAD in young women, causing 24% of MIs.

      Résumé

      Introduction

      La disease non athéroscléreuse de l’artère coronaire (DNAAC) qui est une cause importante d’infarctus du myocarde (IM) chez les jeunes femmes passe souvent inaperçue à l’angiographie coronarienne, et ce, particulièrement dans le cas de dissection spontanée de l’artère coronaire (DSAC). La prévalence de la DNAAC chez les jeunes femmes n’a pas été décrite.

      Méthodes

      Nous avons passé en revue de manière rétrospective tous les angiogrammes coronariens de femmes de 50 ans et moins du Vancouver General Hospital du 1er décembre 2009 au 30 novembre 2011. Les angiogrammes ont été revus par 2 cardiologues expérimentés en cardiologie interventionnelle, et ont été rapportés comme étant normaux (sténose < 30 %), montrant une disease athéroscléreuse de l’artère coronaire (DAAC) ou une DNAAC. La DNAAC a davantage été classifiée comme étant une DSAC, une dysplasie fibromusculaire coronarienne (DFC), une ectasie, une vascularite, une embolie, une anomalie congénitale ou d’étiologie incertaine.

      Résultats

      Parmi les 7605 angiogrammes coronariens réalisés, 177 ont été subis par des femmes de 50 ans et moins. L’âge moyen était de 45,4 ± 4,9 (étendue, 31-50) ans, 76 des 177 (42,9 %) femmes présentaient un syndrome coronarien aigu, et 66 montraient une troponine positive. Quatre-vingt-dix-sept (97; 54,8 %) femmes avaient des artères normales, 54 (30,5 %) avaient une DAAC, 23 (13,0 %) avaient une DNAAC et 3 (1,7 %) étaient d’étiologie incertaine. Parmi celles ayant une DNAAC, une DSAC a été observée chez 16 d’entre elles (toutes montrant une troponine positive et 13 parmi les 16 avaient une DFC non coronarienne), et 2 avaient l’aspect irrégulier de collier de perles de la DFC coronarienne. La vascularite coronarienne a été suspectée chez 2 femmes, et 5 avaient une ectasie coronarienne. Parmi les femmes ayant un IM (66/177), 19 (28,8 %) avaient des artères normales (3 cardiomyopathies de Takotsubo), 24 (36,4 %) avaient une DAAC, 20 (30,3 %) avaient une DNAAC, 16 (24,2 %) avaient une DSAC, et 3 étaient d’étiologie incertaine.

      Conclusions

      La DNAAC n’était pas rare chez les jeunes femmes (de 50 ans et moins) subissant l’angiographie coronarienne et était une cause importante d’IM, qui s’élevait à 30 %. La DSAC était la DNAAC la plus fréquemment observée chez les jeunes femmes, causant 24 % des IM.
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