Acute myocardial infarction associated with pregnancy.

November 1996 | Volume 125 Issue 9 | Pages 751-762 Purpose: To review available information on the epidemiology, cause, diagnosis, prognosis, and treatment of acute myocardial infarction during pregnancy or in the early postpartum period and to develop guidelines for the management of this condition. Data Sources: MEDLINE and Index Medicus searches and a manual search of bibliographies from reviewed articles. Study Selection: Published reports of well-documented acute myocardial infarction during pregnancy or the early postpartum period or potentially relevant information. Data Extraction: 125 well-documented cases of myocardial infarction were identified. Data Synthesis: The highest incidence seems to occur in the third trimester and in multigravidas older than 33 years of age. Acute myocardial infarction during pregnancy is most commonly located in the anterior wall. The maternal death rate was 21%; death occurred most often at the time of acute myocardial infarction or within 2 weeks of the infarction and was usually related to labor and delivery. Most fetal deaths were associated with maternal deaths. Coronary artery morphology was studied in 54% of described patients. Coronary atherosclerosis with or without intracoronary thrombus was found in 43% of patients, coronary thrombus without atherosclerotic disease in 21%, coronary dissection in 16%, and normal coronary arteries in 29%. Conclusions: Acute myocardial infarction during pregnancy or the early postpartum period is rare but may be associated with high risk. Although atherosclerosis can be documented in many cases, coronary dissection and arteries that are normal on angiography are common, especially in acute myocardial infarction occurring in the peripartum or postpartum period. Early diagnosis is often hindered by the normal changes of pregnancy and low level of suspicion. Management should follow the usual principles of care for acute myocardial infarction. However, selection of diagnostic and therapeutic approaches may be greatly influenced by fetal safety. Acute myocardial infarction rarely occurs in women of childbearing age and has been estimated to occur in only 1 in 10 000 women during pregnancy Methods A literature search for acute myocardial infarction during pregnancy was done using MEDLINE and Index Medicus. All original articles were obtained from the University of Southern California library, interlibrary communications, or the authors of the articles. Translators were used to translate all original articles written in foreign languages. Only cases of acute myocardial infarction that were documented by chest pain, standard electrocardiographic criteria, and enzymatic changes (or histologic changes in patients who died) were selected for review. Six cases that were described as acute myocardial infarction but did not fulfill the aforementioned criteria were excluded from the analysis. Epidemiologic data were used to compare selected patients who had acute myocardial infarction in the antepartum (as many as 24 hours before labor), peripartum (within 24 hours before or after delivery), and postpartum (from 24 hours to 3 months after delivery) periods. We make recommendations on the basis of available information, with the understanding that the 125 case