Coronary heart disease (CHD), together with its most serious manifestation—acute coronary syndrome (ACS), seldom occurs in women during pregnancy. However, the real frequency of stable CHD and ACS is difficult to assess, considering the scarcity of precise data. The majority of reports estimate only the incidence of acute myocardial infarction resulting in conflicting rates of CHD/ACS in the literature with an incidence around 1 in 36 000 to 1 in 16 000 deliveries.1 According to the data from the current Registry Of Pregnancy And Cardiac disease (ROPAC), CHD is observed in 2% of pregnant women (based on data from 2007 forward), with about 3000 patients with structural heart diseases.2

Presently, we are witnessing an increased mortality rate in pregnant women, probably due to cardiovascular events. According to the US Pregnancy Mortality Surveillance System, the aggregate pregnancy-related mortality ratio (for the 8-year period, 1998–2005) was 14.5 per 100 000 live births, which is higher than any period in the previous 20 years. Additionally, deaths associated with medical conditions, especially cardiovascular conditions, account for an increasing percentage of pregnancy-related deaths.3 Similarly, in the UK, deaths due to cardiovascular diseases in pregnancy have been increasing over the past 30 years, with a recent incidence of around 2.3 per 100 000 maternities. Coronary disease contributed to 20% of these deaths …