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Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome
  1. Luke J Burchill1,
  2. Heleen Lameijer2,
  3. Jolien W Roos-Hesselink3,
  4. Jasmine Grewal4,
  5. Titia PE Ruys3,
  6. Julia D Kulikowski5,
  7. Laura A Burchill5,
  8. M A Oudijk6,
  9. Rachel M Wald5,
  10. Jack M Colman5,
  11. Samuel C Siu6,
  12. Petronella G Pieper2,
  13. Candice K Silversides5
  1. 1Knight Cardiovascular Institute, Oregon Health Science University, Portland, Oregon, USA
  2. 2Division of Cardiology, Thorax Center, Groningen, The Netherlands
  3. 3Division of Cardiology, Erasmus University Medical Centre, University Medical Centre, Rotterdam, The Netherlands
  4. 4Division of Cardiology, University of British Columbia, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
  5. 5Division of Cardiology, University of Toronto, Mount Sinai Hospital and University Health Network, Toronto, Canada
  6. 6Department of Obstetrics and Gynaecology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
  7. 7Division of Cardiology, University of Western Ontario, University Hospital, London, Canada
  1. Correspondence to Dr Candice K Silversides, Mount Sinai Hospital, OPG Building, 700 University Avenue, 3rd Floor, Room 9-132, Toronto, Ontario, Canada M5G 2N2; candice.silversides{at}uhn.ca

Abstract

Objective The objective of this study was to determine outcomes in pregnant women with pre-existing coronary artery disease (CAD) or following an acute coronary syndrome (ACS) including myocardial infarction (MI).

Background The physiological changes of pregnancy can contribute to myocardial ischaemia. The pregnancy risk for women with pre-established CAD or a history of ACS/MI is not well studied.

Methods This was a retrospective multicentre study. Adverse maternal cardiac, obstetric and fetal/neonatal events were examined. The primary outcome was a composite endpoint of cardiac arrest, ACS/MI, ventricular arrhythmia or congestive heart failure. The prevalence of new or progressive angina during pregnancy was also examined.

Results Fifty pregnancies in 43 women (mean age 35±5 years) were included. Coronary atherosclerosis (40%) and coronary thrombus (36%) were the most common underlying diagnoses. The primary outcome occurred in 10% (5/50) of pregnancies and included one maternal death secondary to cardiac arrest. Other events included ACS/MI (3/50) and heart failure (1/50). New or progressive angina occurred in 18% of pregnancies. Ischaemic complications of any type (new or progressive angina, ACS/MI, ventricular arrhythmia, cardiac arrest) occurred more commonly in women with coronary atherosclerosis compared with those without (50% vs 10%, p=0.003). A high rate of adverse obstetric (16%) and fetal/neonatal (30%) events was observed.

Conclusions Pregnant women with pre-existing CAD or ACS/MI before pregnancy are at increased risk of adverse events during pregnancy. Those with coronary atherosclerosis are at highest risk of adverse maternal cardiac events due to myocardial ischaemia during pregnancy.

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