What does this research mean for the field?

A history of preterm delivery is associated with a significantly higher risk of major adverse cardiovascular events (MACE) and mortality in women following their first coronary artery stenting. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 30, 2022JACC AdvancesOpen Access

Long-Term Outcome Following Coronary Artery Stenting by History of Preterm Delivery

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Why the study?

Preterm delivery is a female-specific risk factor for coronary artery disease, but its relevance in coronary artery disease treatment outcomes is unknown.

Does a history of preterm delivery increase the risk of MACE and mortality in women aged ≤65 years receiving their first coronary stent?

Structured PICO

Does a history of preterm delivery increase the risk of MACE and mortality in women aged ≤65 years receiving their first coronary stent?

Population

5,766 Swedish women aged ≤65 years receiving their first coronary stent during 2006 to 2017.

Intervention

History of preterm delivery

Comparator

No history of preterm delivery

Outcome

Major adverse cardiovascular event (MACE) at >30 days from stentingcomposite

A history of preterm delivery is associated with a significantly higher risk of MACE and mortality in women undergoing their first coronary artery stenting, highlighting its importance as a risk factor in secondary prevention.

Implication

May signal higher MACE risk after stenting in younger women; leaves open whether it should guide secondary prevention.

Abstract

Women are at a greater risk of a major adverse cardiovascular event (MACE) after percutaneous coronary intervention than men. A history of preterm delivery is a female-specific risk factor for coronary artery disease, but its relevance in the treatment of coronary artery disease is unknown. The purpose of this study was to analyze the association between a history of preterm delivery and MACE after the first coronary artery stenting. We included a nationwide sample of 5,766 Swedish women aged ≤65 years receiving their first coronary stent during 2006 to 2017. To adjust for periprocedural characteristics and estimate the association between a history of preterm delivery and MACE at >30 days from stenting, we used proportional hazards regression. We also investigated mortality by history of preterm delivery. During a median follow-up time of 3.7 years (IQR: 1.3-6.7 years), 1,200 (20.8%) women had a MACE. In total, 963 (16.7%) women had a history of preterm delivery. A history of preterm delivery was associated with a higher risk of MACE (adjusted HR: 1.19; 95% CI: 1.03-1.38) and mortality (adjusted HR ratio: 1.38; 95% CI: 1.02-1.85). Similar associations were observed when excluding women with a history of hypertensive disorders of pregnancy or diabetes. Subgroup analyses suggested that women with a history of early preterm delivery had lower risk of MACE than those who had late preterm delivery (P = 0.04). History of preterm delivery is associated with worse prognosis following the first coronary artery stenting in women and warrants consideration as a risk factor also in the secondary prevention setting.