(P043) THE PREVALENCE AND EFFECTS OF THE USE OF EXOGENOUS HORMONES IN PATIENTS PRESENTING WITH SPONTANEOUS CORONARY ARTERY DISSECTION

Background: The population use of exogenous sex hormones is relatively high for indications such as contraception, infertility, fibroids, and postmenopausal symptoms. Spontaneous coronary artery dissection (SCAD) is an increasingly recognised cause of non-atherosclerotic myocardial infarction (MI) particularly in women. The use of exogenous hormones has been temporally associated with SCAD in 10-15% of cases. However, there is no direct evidence linking the use of exogenous hormones and the risk of SCAD or its recurrence. This study aims to determine the prevalence of exogenous hormone use in patients presenting with SCAD, and the associated long-term outcomes.

METHODS AND RESULTS: Patients presenting with SCAD were enrolled in our prospective Canadian SCAD registries. We compared the demographics and outcomes between patients who did and did not use exogenous hormones at the time of SCAD. We divided exogenous hormonal therapy into oral contraceptive (OCP) and hormone replacement therapy (HRT). Subjects were classified based on medication review or self-reported hormone use history. Of 1373 patients in our SCAD registry at time of review, 1199 (87.3%) were women; of these, 236 (19.7%) had previously used HRT, 63 (5.3) had used in vitro fertilization, and 690 (57.5%) had previously used OCP. Amongst women with SCAD, 51 (4.3%) were on OCP and 94 (7.8%) were on HRT at the time of SCAD. Overall, 682 (56.9%) were post-menopausal, and 364 (30.3%) were still having regular menstrual cycles at the time of SCAD.

Patients not using exogenous hormones were more likely to have hypertension (35.9% vs 23.0%, p=0.003) and dyslipidemia (23.9% vs 11.9%, p=0.001) compared to patients using exogenous hormones. Patients on HRT at SCAD presentation had higher rates of hypertension (30.9% vs 15.7%, p=0.03) compared to patients using OCP at SCAD presentation. At mean follow-up of 5.2 +/- 3.8 years for patients using exogenous hormones, 25 (17.2%) had overall MACE (death, stroke, recurrent MI, revascularization). There were no difference in in-hospital or overall MACE, death, or recurrent SCAD between patients with or without exogenous hormone use at baseline (table 1). There was also no difference in outcomes between patients using OCP compared to those using HRT.

Conclusion: There were no significant difference between in-hospital and long-term outcomes between patients who did or did not use exogenous hormones at the time of SCAD. Patients with SCAD are generally dissuaded from exogenous hormone use, however, further investigations on exogenous hormone are needed to determine if SCAD patients accrue higher risk.