Pregnancy-Related Acute Myocardial Infarction in Japan

Hiroshi Satoh, Makoto Sano, Kenichiro Suwa, Masao Saotome, Tsuyoshi Urushida, Hideki Katoh, Hideharu Hayashi
2013 Circulation Journal  
Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp obstetricians must understand the incidence, risk factors, and etiology of pregnancy-related AMI to enable immediate diagnosis and adequate medical and obstetric management. The present study retrospectively reviews case reports of pregnancy-related AMI from medical institutions in Japan over the past 30 years, and compares the epidemiology, etiology and treatment with those of published
more » ... ublished population-based studies. Methods We searched the English language MEDLINE bibliographical database for pregnancy-related AMI in Japan. The Japanese literature was searched using the University Hospital Medical Information Network Electronic Library for Biomedical Science (UMIN ELBIS), and the databases of the Japanese Circulation Society, the Japanese Society of Internal Medicine and the Japanese Society of Obstetrics and Gynecology. The key words for all searches were AMI, acute coronary syndrome, schemic heart disease in women of reproductive age is uncommon, but pregnancy increases the risk of acute myocardial infarction (AMI) by 3-4 fold. 1-4 In Western countries, the incidence of pregnancy-related AMI has been reported as 0.7-6.2 cases per 100,000 pregnancies. 3-6 The incidence of pregnancy-related AMI seems much lower in Japan than in Western countries, but a population-based study has not been described, and data mostly comprise case reports from various institutions. 7-15 Editorial p 606 The occurrence of pregnancy-related AMI is increasing with the continuing trend of childbearing at older ages and advances in reproductive technology enabling many older women to conceive. 16,17 The rarity of pregnancy-related AMI makes it difficult to diagnose. However, AMI can occur at any time, including during pregnancy, delivery and postpartum, and can result in maternal and/or fetal death. Both cardiologists and I Background: Pregnancy-related acute myocardial infarction (AMI) is uncommon, but can result in maternal and/or fetal death. This study retrospectively reviews pregnancy-related AMI reported from medical institutions in Japan. Methods and Results: We electronically or manually searched the literature for reports of pregnancy-related AMI between 1981 and 2011. In total, 62 patients were described and the numbers increased in accordance with the rising average age of the mothers. AMI occurred frequently in women aged 30-34 years (mean age, 33), in the third trimester and postpartum (n=11 and n=28, respectively). The prevalence of conventional risk factors was relatively low (n=21). On the other hand, 29 patients had obstetric and/or non-obstetric complications, and 24 received medication. Only 8 AMI were caused by atherosclerosis, while coronary dissection, thrombus and spasm were the cause in 14, 9 and 12 cases, respectively. All patients with atherosclerosis had conventional risk factors, and some patients with spasm had a history of smoking. Medication with ergot derivatives was associated mostly with spasm, whereas ritodrine was potentially related to dissection. Conclusions: The prevalence of pregnancy-related AMI in Japan seems lower than in Western countries, and the etiology differs considerably. However, as the trend of later childbearing continues, more pregnant women have more risk factors, complications, and require medication. Cardiologists and obstetricians must consider the increased risk of AMI. (Circ J 2013; 77: 725 -733)
doi:10.1253/circj.cj-12-1001 pmid:23182760 fatcat:xibtqkr2yfc5pcr2vg36wzligu