Acute Coronary Syndrome and Ischemic Heart Disease in Pregnancy: Data From the EURObservational Research Programme‐European Society of Cardiology Registry of Pregnancy and Cardiac Disease

Abstract

Background The prevalence of ischemic heart disease (IHD) in women of child‐bearing age is rising. Data on pregnancies however are scarce. The objective is to describe the pregnancy outcomes in these women. Methods and Results The European Society of Cardiology‐EURObservational Research Programme ROPAC (Registry of Pregnancy and Cardiac Disease) is a prospective registry in which data on pregnancies in women with heart disease were collected from 138 centers in 53 countries. Pregnant women with preexistent and pregnancy‐onset IHD were included. Primary end point were maternal cardiac events. Secondary end points were obstetric and fetal complications. There were 117 women with IHD, of which 104 had preexisting IHD. Median age was 35.5 years and 17.1% of women were smoking. There was no maternal mortality, heart failure occurred in 5 pregnancies (4.8%). Of the 104 women with preexisting IHD, 11 women suffered from acute coronary syndrome during pregnancy. ST‐segment‒elevation myocardial infarction were more common than non‒ST‐segment‒elevation myocardial infarction, and atherosclerosis was the most common etiology. Women who had undergone revascularization before pregnancy did not have less events than women who had not. There were 13 women with pregnancy‐onset IHD, in whom non‒ST‐segment‒elevation myocardial infarction was the most common. Smoking during pregnancy was associated with acute coronary syndrome. Caesarean section was the primary mode of delivery (55.8% in preexisting IHD, 84.6% in pregnancy‐onset IHD) and there were high rates of preterm births (20.2% and 38.5%, respectively). Conclusions Women with IHD tolerate pregnancy relatively well, however there is a high rate of ischemic events and these women should therefore be considered moderate‐ to high‐risk. Ongoing cigarette smoking is associated with acute coronary syndrome during pregnancy.

Pregnancy-related acute myocardial infarction: a review of the recent literature

“…This probably follows significant improvements in diagnosis and treatment over time and bias in collecting data mainly from severe or fatal cases in older reports. Accordingly, in the largest prospective study to date on pregnant women affected by acute coronary syndromes, no maternal deaths were recorded [ 35 ]. In line with this result, another recent study observed comparable rates of in-hospital mortality after AMI between pregnant women and the general population.…”

“…Moreover, the recent literature suggests that rates of CS are notably higher in women with pregnancy-related AMI, more than twice those in healthy women in Europe [ 35 , 72 ]. Indeed, CS appears to be the safest approach to delivery after an acute cardiac event.…”

“…Pregnancy-related AMI due to CAD shows a fairly uniform incidence during gestation [ 16 ]. In a European registry analysis of pregnant women and cardiovascular diseases, CAD was reported to occur even more commonly than SCAD [ 35 ].…”

Rationale, design and protocol of a cross-sectional study on pregnancy-related cardiovascular diseases in Tanzania (PRECARDT): burden, characterisation and prognostic significance at delivery

“…Of note, more recent results from the large EURObservational Research Programme Registry of Pregnancy and Cardiac disease registry have added to our understanding of the maternal and fetal outcomes of women with different cardiac conditions, including women with uncorrected CHD, 15 transposition of great arteries, 16 aortic coarctation 17 and in those with ischaemic heart disease. 18 Most of these studies are predominantly from HIC, and many have focused on women with CHD 15-17 19-21 as well as in general CVDs. 2 3 18 22 23 Although the majority of studies have reported an increased risk of adverse maternal and fetal outcomes, 3 15 19 20 22-26 others did not show this increased risk.…”

Elevated cardiovascular disease risk in low-income women with a history of pregnancy loss

“…Profound physiological changes including significant hormonal, metabolic and haemodynamic shifts and their impact on cardiovascular and pulmonary systems during pregnancy are widely recognised. Studies have found that women with any history of pregnancy have increased long-term risk of hypertension,1 ischaemic heart disease (IHD),1 myocardial infarction (MI),2–4 ischaemic stroke and intracerebral haemorrhage,5–9 venous and arterial thromboembolism 10 11…”