Systematic Review of Acute Coronary Artery Revascularization During Pregnancy

Acute coronary syndrome during pregnancy is rare but its incidence may rise in the future due to increasing rates of cardiovascular risk factors in young adults. Little is known about revascularization strategies and outcomes among pregnant patients. Therefore, we performed a systematic search of published cases of coronary revascularization during pregnancy with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. A total of 60 cases of PCI (n=42) and CABG (n=19) were included (1 case with both). The median age at presentation was 33 [31,38] years. The median gestational age was 22 [12,32] weeks. Most patients presented in the third trimester (38%). The most common cardiovascular and obstetric risk factors included hypertension (23%), previous (44%) and current tobacco use (34%), and advanced maternal age (37%). Patients most commonly presented with ST-elevated myocardial infarction (63%) and lesions in the left anterior descending artery (72%). The overall procedural complication rate was 11.7% (95% CI 4.8% to 22.6%) for all cases, 16.7% (7.0% to 31.4%) for PCI, and 5.3% (0.1% to 26.0%) for CABG. The overall rate of successful delivery was 83.3% (95% CI 68.6% to 93.0%), with most pregnancies resulting in cesarean deliveries (69%). In conclusion, this systematic review of published cases of coronary artery revascularization during pregnancy found low rates of procedural complications and high rates of successful deliveries. Hypertension, tobacco use, and advanced maternal age were common risk factors preceding presentation.