Risk factor modification for AMI needed in pregnant women

Acute myocardial infarction (AMI) during pregnancy is driven by factors such as known coronary artery disease, hyperlipidaemia, obesity, and smoking history, among others, a study has found. These risk factors contribute to poor outcomes and highlight the need for modification in order to prevent AMI in the pregnant population.

The study involved a cohort of 11,297,849 women, among whom 913 women developed AMI (0.008 percent). Of these, 111 women (12.2 percent) had AMI during labour and delivery, 338 (37.0 percent) during pregnancy, and 464 (50.8 percent) during the postpartum period.

There was a clear trend of increasing AMI in pregnancy noted between 2003 and 2015 (p=0.0005). Furthermore, a lot of major adverse cardiovascular and cerebrovascular events occurred in the postpartum period (63.5 percent). Inpatient mortality was 4.5 percent.

In multivariable logistic regression models, predictors of AMI included known coronary artery disease (odds ratio [OR], 517.4, 95 percent confidence interval [CI], 420.8–636.2), heart failure (OR, 8.2, 95 percent CI, 1.9–35.2), prior valve replacement (OR, 6.4, 95 percent CI, 2.4–17.1), and atrial fibrillation (OR, 2.7, 95 percent CI, 1.5–4.7; p<0.001 for all).

With respect to known risk factors for traditional atherosclerosis, hyperlipidaemia, obesity, tobacco history, substance abuse, and thrombophilia were all associated with AMI (p<0.001).

Other significant risk factors for AMI were gestational hypertensive disorders, such as eclampsia (OR, 6.0, 95 percent CI, 3.3–10.8) and pre-eclampsia (OR, 3.2, 95 percent CI, 2.5–4.2).

Meanwhile, major adverse cardiovascular and cerebrovascular events were associated with prior percutaneous coronary intervention (OR, 6.6, 95 percent CI, 1.4–31.2) and pre‐eclampsia (OR, 2.3, 95 percent CI, 1.3–3.9).