Abstract 18913: Spontaneous Coronary Artery Dissection in Women and Association With Hormonal Stressors
Bibliographic record
Abstract
Background: Spontaneous coronary artery dissection (SCAD) is an infrequent but important cause of myocardial infarction (MI) in women. Chronic exposure to hormonal therapy, fluctuation in hormonal levels, and a history of multiple pregnancies had been postulated to predispose to SCAD. However, these were not well described in the literature. Methods: Women with SCAD who have consented and are prospectively followed in our Vancouver General Hospital SCAD registries are included in this study. Their background hormonal exposure, pregnancy, and gynaecological histories were extracted from questionnaires, clinical histories, and medical records. These were correlated to in-hospital and long-term outcomes. Results: We included 187 women with SCAD, with mean age 52.6 ± 8.7 years. The majority were Caucasian (83.4%) and 74.0% had fibromuscular dysplasia. All patients presented with MI. Mean number of pregnancy in this cohort was 2.5, with 45 (24.1%) and 25 (13.4%) having ≥4 and ≥5 pregnancies, respectively. Mean number of live births (parity) was 1.8, with 52 (27.8%) having ≥3 births, and 16 (8.6%) having ≥4 births. There were 3 post-partum SCAD (<1 year) and they were still breastfeeding. In terms of hormonal therapy, 28 (15.0%) were actively on hormonal therapy; 5 (2.7%) had prior fertility treatment, 51 (27.3%) had hormone replacement therapy (HRT), 76 (40.6%) had oral contraception, and 36 (19.3%) had gynaecological procedures. There were 107 (57.2%) post-menopausal women, and 23 (12.3%) were peri-menopausal at presentation. There was no death during acute SCAD admission, but 3 died at follow-up (mean 4.1 ± 3.9yrs), and 36 (19.3%) had recurrent SCAD. Patients actively on hormones had higher rate of recurrent SCAD (32.1% vs. 15.8%, p=0.039). There was a higher recurrent MI rate in premenopausal women during index admission (8.9% vs. 1.9%, p=0.037). There was no significant difference in in-hospital and follow-up events in women with past hormonal therapy, post-partum women, or those with parity ≥4 or gravida ≥5. Conclusion: Significant proportion of women with SCAD had exposure to hormonal therapy or had multiple pregnancies/births. Patients actively on hormonal therapy appeared to have higher recurrent SCAD events at follow-up.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".