title: Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome.
abstract: OBJECTIVE
  The objective of this study was to determine outcomes in pregnant women with pre-existing coronary artery disease (CAD) or following an acute coronary syndrome (ACS) including myocardial infarction (MI).
  
  
  BACKGROUND
  The physiological changes of pregnancy can contribute to myocardial ischaemia. The pregnancy risk for women with pre-established CAD or a history of ACS/MI is not well studied.
  
  
  METHODS
  This was a retrospective multicentre study. Adverse maternal cardiac, obstetric and fetal/neonatal events were examined. The primary outcome was a composite endpoint of cardiac arrest, ACS/MI, ventricular arrhythmia or congestive heart failure. The prevalence of new or progressive angina during pregnancy was also examined.
  
  
  RESULTS
  Fifty pregnancies in 43 women (mean age 35±5 years) were included. Coronary atherosclerosis (40%) and coronary thrombus (36%) were the most common underlying diagnoses. The primary outcome occurred in 10% (5/50) of pregnancies and included one maternal death secondary to cardiac arrest. Other events included ACS/MI (3/50) and heart failure (1/50). New or progressive angina occurred in 18% of pregnancies. Ischaemic complications of any type (new or progressive angina, ACS/MI, ventricular arrhythmia, cardiac arrest) occurred more commonly in women with coronary atherosclerosis compared with those without (50% vs 10%, p=0.003). A high rate of adverse obstetric (16%) and fetal/neonatal (30%) events was observed.
  
  
  CONCLUSIONS
  Pregnant women with pre-existing CAD or ACS/MI before pregnancy are at increased risk of adverse events during pregnancy. Those with coronary atherosclerosis are at highest risk of adverse maternal cardiac events due to myocardial ischaemia during pregnancy.
authors.affiliation: Knight Cardiovascular Institute, Oregon Health Science University, Portland, Oregon, USA.
authors.forename: Luke J
authors.initials: LJ
authors.lastname: Burchill
authors.affiliation: Division of Cardiology, Thorax Center, Groningen, The Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Lameijer
authors.affiliation: Division of Cardiology, Erasmus University Medical Centre, University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Division of Cardiology, University of British Columbia, Providence Health Care, St. Paul's Hospital, Vancouver, Canada.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Grewal
authors.affiliation: Division of Cardiology, Erasmus University Medical Centre, University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Titia P E
authors.initials: TP
authors.lastname: Ruys
authors.affiliation: Division of Cardiology, University of Toronto, Mount Sinai Hospital and University Health Network, Toronto, Canada.
authors.forename: Julia D
authors.initials: JD
authors.lastname: Kulikowski
authors.affiliation: Division of Cardiology, University of Toronto, Mount Sinai Hospital and University Health Network, Toronto, Canada.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Burchill
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Oudijk
authors.affiliation: Division of Cardiology, University of Toronto, Mount Sinai Hospital and University Health Network, Toronto, Canada.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Wald
authors.affiliation: Division of Cardiology, University of Toronto, Mount Sinai Hospital and University Health Network, Toronto, Canada.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Colman
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Siu
authors.affiliation: Division of Cardiology, Thorax Center, Groningen, The Netherlands.
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
authors.affiliation: Division of Cardiology, University of Toronto, Mount Sinai Hospital and University Health Network, Toronto, Canada.
authors.forename: Candice K
authors.initials: CK
authors.lastname: Silversides
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000328:Adult; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000209:etiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors