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Acute coronary syndrome in pregnancy: time to act
  1. Cathy Nelson-Piercy1,
  2. Dawn Adamson2,
  3. Marian Knight3
  1. 1Women's Health Academic Centre, Guy's & St Thomas' Foundation Trust, London, UK
  2. 2Department of Cardiology, University Hospital, Coventry, UK
  3. 3National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
  1. Correspondence to Professor Cathy Nelson-Piercy, Professor of Obstetric Medicine, King's College London, Consultant Obstetric Physician, Imperial College Healthcare Trust and Guy's & St Thomas' Foundation Trust, 10th Floor, North Wing Directorate Office, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; catherine.nelson-piercy{at}gstt.nhs.uk

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Cardiac disease is the leading cause of death in pregnancy and the puerperium in the UK, and was responsible for 20% of the maternal deaths between 2006 and 2008.1 Ischaemic heart disease and myocardial infarction (MI) are the most common pathologies, being the cause of 20% of the maternal cardiac deaths.1 Although the UK has excellent anonymised data regarding maternal mortality due to cardiac conditions from the Confidential Enquiries, a triennial report into maternal deaths,1 until recently there were no data on incidence and morbidity in pregnancy. A recent UK-wide prospective population based study with nested case control analysis using the UK Obstetric Surveillance System (UKOSS) identified only 25 cases of MI (diagnosed according to joint European Society of Cardiology/American College of Cardiology criteria) between 2005 and 2010, giving an incidence of 0.7 per 100 000 maternities (95% CI 0.5 to 1.1).2

The risk factors for MI in pregnancy are the same as those outside pregnancy: smoking, diabetes, hyperlipidaemia, hypertension and family history as well as increasing age and obesity. One factor that may explain the increased maternal deaths from MI is the increasing number of older women becoming pregnant. Eight out of 11 of the maternal deaths from ischaemic heart disease and MI in the last Confidential Enquiry1 were in …

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