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Acute myocardial infarction in pregnancy: a statewide analysis.

OBJECTIVE
Acute myocardial infarction (AMI) during pregnancy and the puerperium is a rare but devastating event. The objective of this study was to describe the clinical and epidemiological features of pregnancy-related AMI.


METHODS
A retrospective study was conducted using Texas hospital inpatient data (years 2004-2007). Diagnoses and procedures had been coded using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Adjusted odds ratios (OR) for hospital mortality and length of stay >4 days (prolonged length of stay [PLOS]) were calculated using logistic regression with Firth's bias correction and multiple imputation.


RESULTS
103 women with pregnancy-related AMI were identified in the statewide hospital database (6.5 cases per 100,000 births). The prevalence of cardiomyopathy was 16.5%. Approximately 14% of the pregnancies were complicated by preeclampsia/eclampsia. A history of cocaine use was noted in 3 patients. Congestive heart failure was present in 18 patients (17.5%). Two patients had attempted suicide and 1 died in the hospital. The overall hospital mortality rate was 9.7%. Placement of coronary artery stents was the most common coronary revascularization procedure (11 patients or 10.7%). The adjusted hospital mortality OR for women 35-39 years old (versus 30-34 years old) was 6.29 (P = .07). Patients with preeclampsia were more likely to have PLOS than patients whose deliveries were not complicated by preeclampsia (OR, 3.84; P = .06).


CONCLUSIONS
While AMI in pregnancy remains a rare occurrence, it is associated with significant morbidity and a high case-fatality rate.