STEMI, Revascularization, and Peak Troponin by Adverse Pregnancy Outcomes in Women With Myocardial Infarction

Moa Handmark, MD; Annie Lin, MD; Andreas Edsfeldt, MD, PhD; Giovanna Sarno, MD, PhD; Abigail Fraser, PhD; Janet W. Rich-Edwards, ScD; Isabel Gonҫalves, MD, PhD; Mats Pihlsgård, PhD; Simon Timpka, MD, PhD

JACC: Advances (Aug 2024)

STEMI, Revascularization, and Peak Troponin by Adverse Pregnancy Outcomes in Women With Myocardial Infarction

Moa Handmark, MD,
Annie Lin, MD,
Andreas Edsfeldt, MD, PhD,
Giovanna Sarno, MD, PhD,
Abigail Fraser, PhD,
Janet W. Rich-Edwards, ScD,
Isabel Gonҫalves, MD, PhD,
Mats Pihlsgård, PhD,
Simon Timpka, MD, PhD

Affiliations

Moa Handmark, MD: Perinatal and Cardiovascular Epidemiology and Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Address for correspondence: Dr Moa Handmark, Perinatal and Cardiovascular Epidemiology (PACE), Lund University, Clinical Research Center, Box 50332, 202 13 Malmö, Sweden.
Annie Lin, MD: Perinatal and Cardiovascular Epidemiology and Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
Andreas Edsfeldt, MD, PhD: Cardiovascular Research - Translational Studies, Lund University, Malmö, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Department of Cardiology, Skåne University Hospital, Lund/Malmö, Sweden
Giovanna Sarno, MD, PhD: Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
Abigail Fraser, PhD: Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
Janet W. Rich-Edwards, ScD: Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
Isabel Gonҫalves, MD, PhD: Cardiovascular Research - Translational Studies, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Lund/Malmö, Sweden
Mats Pihlsgård, PhD: Perinatal and Cardiovascular Epidemiology and Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
Simon Timpka, MD, PhD: Perinatal and Cardiovascular Epidemiology and Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Obstetrics and Gynaecology, Skåne University Hospital, Malmö, Sweden

Journal volume & issue: Vol. 3, no. 8
p. 101088

Abstract

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Background: Women with a history of adverse pregnancy outcomes have a higher risk of coronary heart disease. Emerging evidence suggests that women with a history of preeclampsia have a different pattern of overall coronary atherosclerosis and that they at the time of myocardial infarction (MI) more frequently present with ST-segment elevation MI (STEMI) compared to women with no such history. Objectives: The purpose of this study was to determine whether among women with MI, those with a history of adverse pregnancy outcomes are more likely to present with STEMI or other clinical characteristics indicating a more severe myocardial injury. Methods: The study sample consisted of 8,320 women aged ≤65 years with first MI in Sweden 2007 to 2022. Regression models were used to estimate the association between adverse pregnancy outcomes (hypertensive disorders of pregnancy [non-preeclamptic hypertension and preeclampsia], small for gestational age [SGA] infant, and preterm delivery) and STEMI, invasive revascularization, and high troponin, while considering known predictors of coronary heart disease. Results: In total, 3,128 (38%) of women suffered STEMI. The adjusted OR of presenting with STEMI were higher in women with a history of preterm preeclampsia (OR: 1.40; 95% CI: 1.05-1.88), or an SGA infant (OR: 1.30; 95% CI: 1.13-1.50) compared to women with no such history, as well as for in-hospital revascularization. Stratified by infarct type, troponin levels did not differ by adverse pregnancy outcome history. Conclusions: Among women with a first MI, a history of preterm preeclampsia or SGA infant were associated with STEMI and invasive revascularization.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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