Key result
Adverse pregnancy outcomes linked to premature MI ~2 years earlier following delivery.
Why the study?
Adverse pregnancy outcomes are associated with later ischemic heart disease, but the features of premature MI among women with and without prior APOs required study.
Does a history of adverse pregnancy outcomes affect the timing and characteristics of premature myocardial infarction in women?
Observational (n=391)
Does a history of adverse pregnancy outcomes affect the timing and characteristics of premature myocardial infarction in women?
Absolute Event Rate: 19.6% vs 21.5%
p-value: p=0.012
Women with a history of adverse pregnancy outcomes present with premature myocardial infarction sooner after pregnancy than those without, highlighting the need for early cardiovascular prevention.
APO history may flag women for earlier CVD prevention; leaves open whether it modifies premature MI phenotype or mechanisms.
Adverse pregnancy outcomes (APOs), hypertensive disorders of pregnancy, gestational diabetes mellitus, and preterm birth are associated with ischemic heart disease in later life. The authors aimed to study the features of premature myocardial infarction (MI) among women with and without prior APOs. We performed a retrospective analysis of women with premature MI (<65 years of age) referred for left heart catheterization matched with a database of abstracted pregnancy data. We compared MI characteristics and epicardial coronary anatomy between women with and without APOs during their index pregnancy and evaluated time from delivery to MI. Of 391 women with premature MI and associated coronary angiography (age: 49 ± 8 years), 154 (39%) had a prior APO (hypertensive disorders of pregnancy n = 78, preeclampsia n = 35, gestational diabetes mellitus n = 28, and preterm birth n = 48). Women with APO history had a higher prevalence of diabetes (33% vs 16% without APO; P = 0.001) and presented earlier with MI following delivery (19.6 [IQR: 14.3-23.5] years vs those without APO 21.5 [IQR: 17.0-25.4] years; P = 0.012), driven by preeclampsia (17.1 [IQR: 12.7-22.4] years, P = 0.010). Women with and without APOs had similar MI features including rates of ST-segment elevation MI, obstructive and multi-vessel coronary artery disease, percutaneous coronary intervention, and shock. Among women with premature MIs, 39% had a history of an APO. Women with APO history presented sooner after pregnancy but had similar MI characteristics vs those without APOs. Pregnancy history may identify women who warrant early, aggressive cardiovascular disease prevention.
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Countouris et al. (2023) conducted an observational in Premature myocardial infarction (n=391). Prior adverse pregnancy outcomes (APOs) vs. No prior APOs was evaluated on Time from delivery to MI (p=0.012). Women with a history of adverse pregnancy outcomes presented earlier with premature myocardial infarction following delivery compared to those without (19.6 vs 21.5 years; P=0.012).
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