Advertisement
Mayo Clinic Proceedings Home

Acute Myocardial Infarction During Pregnancy and the Puerperium in the United States

      Abstract

      Objective

      To analyze trends in the incidence, in-hospital management, and outcomes of acute myocardial infarction (AMI) complicating pregnancy and the puerperium in the United States.

      Patients and Methods

      Women 18 years or older hospitalized during pregnancy and the puerperium were identified from the National Inpatient Sample database from January 1, 2002, to December 31, 2014. International Classification of Diseases, Ninth Revision diagnosis and procedure codes were used to identify AMI during pregnancy-related admissions.

      Results

      Overall, 55,402,290 pregnancy-related hospitalizations were identified. A total of 4471 cases of AMI (8.1 [95% CI, 7.5-8.6] cases per 100,000 hospitalizations) occurred, with 922 AMI cases (20.6%) identified in the antepartum period, 1061 (23.7%) during labor and delivery, and 2390 (53.5%) in the postpartum period. ST-segment elevation myocardial infarction occurred in 1895 cases (42.4%), and non-ST-segment elevation myocardial infarction occurred in 2576 cases (57.6%). Among patients with pregnancy-related AMI, 2373 (53.1%) underwent invasive management and 1120 (25.1%) underwent coronary revascularization. In-hospital mortality was significantly higher in patients with AMI than in those without AMI during pregnancy (adjusted odds ratio, 39.9; 95% CI, 23.3-68.4; P<.001). The rate of AMI during pregnancy and the puerperium increased over time (adjusted odds ratio, 1.25 [for 2014 vs 2002]; 95% CI, 1.02-1.52).

      Conclusion

      In patients hospitalized during pregnancy and the puerperium, AMI occurred in 1 of every 12,400 hospitalizations and rates of AMI increased over time. Maternal mortality rates were high. Additional research on the prevention and optimal management of AMI during pregnancy is necessary.

      Abbreviations and Acronyms:

      AMI (acute myocardial infarction), aOR (adjusted odds ratio), CABG (coronary artery bypass grafting), CAD (coronary artery disease), FDA (Food and Drug Administration), ICD-9 (International Classification of Diseases, Ninth Revision), NIS (National Inpatient Sample), NSTEMI (non–ST-segment elevation myocardial infarction), PCI (percutaneous coronary intervention), SCAD (spontaneous coronary artery dissection), STEMI (ST-segment elevation myocardial infarction)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Roth A.
        • Elkayam U.
        Acute myocardial infarction associated with pregnancy.
        Ann Intern Med. 1996; 125: 751-762
        • Ladner H.E.
        • Danielsen B.
        • Gilbert W.M.
        Acute myocardial infarction in pregnancy and the puerperium: a population-based study.
        Obstet Gynecol. 2005; 105: 480-484
        • James A.H.
        • Jamison M.G.
        • Biswas M.S.
        • Brancazio L.R.
        • Swamy G.K.
        • Myers E.R.
        Acute myocardial infarction in pregnancy: a United States population-based study.
        Circulation. 2006; 113: 1564-1571
        • Badui E.
        • Enciso R.
        Acute myocardial infarction during pregnancy and puerperium: a review.
        Angiology. 1996; 47: 739-756
        • Roth A.
        • Elkayam U.
        Acute myocardial infarction associated with pregnancy.
        J Am Coll Cardiol. 2008; 52: 171-180
      1. Houchens RL, Ross D, Elixhauser A. Using the HCUP National Inpatient Sample to Estimate Trends. 2015. HCUP Methods Series Report # 2006-05. U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp. Accessed June 5, 2018.

        • Elkayam U.
        • Jalnapurkar S.
        • Barakkat M.N.
        • et al.
        Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011.
        Circulation. 2014; 129: 1695-1702
        • Pope J.H.
        • Aufderheide T.P.
        • Ruthazer R.
        • et al.
        Missed diagnoses of acute cardiac ischemia in the emergency department.
        N Engl J Med. 2000; 342: 1163-1170
        • Kaul P.
        • Chang W.C.
        • Westerhout C.M.
        • Graham M.M.
        • Armstrong P.W.
        Differences in admission rates and outcomes between men and women presenting to emergency departments with coronary syndromes.
        CMAJ. 2007; 177: 1193-1199
        • Levit R.D.
        • Reynolds H.R.
        • Hochman J.S.
        Cardiovascular disease in young women: a population at risk.
        Cardiol Rev. 2011; 19: 60-65
        • Bangalore S.
        • Fonarow G.C.
        • Peterson E.D.
        • et al.
        Get with the Guidelines Steering Committee and Investigators. Age and gender differences in quality of care and outcomes for patients with ST-segment elevation myocardial infarction.
        Am J Med. 2012; 125: 1000-1009
        • Regitz-Zagrosek V.
        • Blomstrom Lundqvist C.
        • et al.
        • European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM)
        ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC).
        Eur Heart J. 2011; 32: 3147-3197
        • Manson J.E.
        • Hsia J.
        • Johnson K.C.
        • et al.
        Women's Health Initiative Investigators. Estrogen plus progestin and the risk of coronary heart disease.
        N Engl J Med. 2003; 349: 523-534
        • Tanis B.C.
        • van den Bosch M.A.
        • Kemmeren J.M.
        • et al.
        Oral contraceptives and the risk of myocardial infarction.
        N Engl J Med. 2001; 345: 1787-1793
        • Saw J.
        • Mancini G.B.
        • Humphries K.H.
        Contemporary review on spontaneous coronary artery dissection.
        J Am Coll Cardiol. 2016; 68: 297-312
        • Lameijer H.
        • Kampman M.A.
        • Oudijk M.A.
        • Pieper P.G.
        Ischaemic heart disease during pregnancy or post-partum: systematic review and case series.
        Neth Heart J. 2015; 23: 249-257
        • Hayes S.N.
        • Kim E.S.H.
        • Saw J.
        • et al.
        • American Heart Association Council on Peripheral Vascular Disease
        • Council on Clinical Cardiology
        • Council on Cardiovascular and Stroke Nursing
        • Council on Genomic and Precision Medicine; and Stroke Council
        Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association.
        Circulation. 2018; 137: e523-e557
        • Smilowitz N.R.
        • Naoulou B.
        • Sedlis S.P.
        Diagnosis and management of type II myocardial infarction: increased demand for a limited supply of evidence.
        Curr Atheroscler Rep. 2015; 17: 478
        • Mehta L.S.
        • Beckie T.M.
        • DeVon H.A.
        • et al.
        • American Heart Association Cardiovascular Disease in Women and Special Populations Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research
        Acute myocardial infarction in women: a scientific statement from the American Heart Association.
        Circulation. 2016; 133: 916-947
        • Kamel H.
        • Navi B.B.
        • Sriram N.
        • Hovsepian D.A.
        • Devereux R.B.
        • Elkind M.S.
        Risk of a thrombotic event after the 6-week postpartum period.
        N Engl J Med. 2014; 370: 1307-1315

      Linked Article