Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome

Luke Burchill, Heleen Lameijer, Jolien W. Roos-Hesselink, Jasmine Grewal, Titia P E Ruys, Julia D. Kulikowski, Laura A. Burchill, M. A. Oudijk, Rachel M. Wald, Jack M. Colman, Samuel C. Siu, Petronella G. Pieper, Candice K. Silversides

    Research output: Contribution to journalArticle

    16 Citations (Scopus)

    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.

    Original languageEnglish (US)
    Pages (from-to)525-529
    Number of pages5
    JournalHeart
    Volume101
    Issue number7
    DOIs
    StatePublished - Apr 1 2015

    Fingerprint

    Acute Coronary Syndrome
    Coronary Artery Disease
    Pregnancy
    Myocardial Infarction
    Heart Arrest
    Obstetrics
    Myocardial Ischemia
    Cardiac Arrhythmias
    Pregnant Women
    Heart Failure
    Mothers
    Maternal Death
    Multicenter Studies
    Thrombosis
    Retrospective Studies

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Medicine(all)

    Cite this

    Burchill, L., Lameijer, H., Roos-Hesselink, J. W., Grewal, J., Ruys, T. P. E., Kulikowski, J. D., ... Silversides, C. K. (2015). Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome. Heart, 101(7), 525-529. https://doi.org/10.1136/heartjnl-2014-306676

    Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome. / Burchill, Luke; Lameijer, Heleen; Roos-Hesselink, Jolien W.; Grewal, Jasmine; Ruys, Titia P E; Kulikowski, Julia D.; Burchill, Laura A.; Oudijk, M. A.; Wald, Rachel M.; Colman, Jack M.; Siu, Samuel C.; Pieper, Petronella G.; Silversides, Candice K.

    In: Heart, Vol. 101, No. 7, 01.04.2015, p. 525-529.

    Research output: Contribution to journalArticle

    Burchill, L, Lameijer, H, Roos-Hesselink, JW, Grewal, J, Ruys, TPE, Kulikowski, JD, Burchill, LA, Oudijk, MA, Wald, RM, Colman, JM, Siu, SC, Pieper, PG & Silversides, CK 2015, 'Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome', Heart, vol. 101, no. 7, pp. 525-529. https://doi.org/10.1136/heartjnl-2014-306676
    Burchill L, Lameijer H, Roos-Hesselink JW, Grewal J, Ruys TPE, Kulikowski JD et al. Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome. Heart. 2015 Apr 1;101(7):525-529. https://doi.org/10.1136/heartjnl-2014-306676
    Burchill, Luke ; Lameijer, Heleen ; Roos-Hesselink, Jolien W. ; Grewal, Jasmine ; Ruys, Titia P E ; Kulikowski, Julia D. ; Burchill, Laura A. ; Oudijk, M. A. ; Wald, Rachel M. ; Colman, Jack M. ; Siu, Samuel C. ; Pieper, Petronella G. ; Silversides, Candice K. / Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome. In: Heart. 2015 ; Vol. 101, No. 7. pp. 525-529.
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    title = "Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome",
    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.",
    author = "Luke Burchill and Heleen Lameijer and Roos-Hesselink, {Jolien W.} and Jasmine Grewal and Ruys, {Titia P E} and Kulikowski, {Julia D.} and Burchill, {Laura A.} and Oudijk, {M. A.} and Wald, {Rachel M.} and Colman, {Jack M.} and Siu, {Samuel C.} and Pieper, {Petronella G.} and Silversides, {Candice K.}",
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    T1 - Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome

    AU - Burchill, Luke

    AU - Lameijer, Heleen

    AU - Roos-Hesselink, Jolien W.

    AU - Grewal, Jasmine

    AU - Ruys, Titia P E

    AU - Kulikowski, Julia D.

    AU - Burchill, Laura A.

    AU - Oudijk, M. A.

    AU - Wald, Rachel M.

    AU - Colman, Jack M.

    AU - Siu, Samuel C.

    AU - Pieper, Petronella G.

    AU - Silversides, Candice K.

    PY - 2015/4/1

    Y1 - 2015/4/1

    N2 - 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.

    AB - 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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