National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
Eur J Prev Cardiol. 2013 Feb;20(1):12-20. doi: 10.1177/1741826711432117. Epub 2011 Nov 29.
Cardiac disease is a leading cause of maternal death in the developed world, responsible for one-fifth of all maternal deaths in the UK. The aim of this study was to estimate the incidence of myocardial infarction (MI) in pregnancy and up to one week postpartum in the UK and describe risk factors, management and outcomes.
A prospective population-based study with nested case control analysis used the UK Obstetric Surveillance System to identify all women in the UK with MI in pregnancy (in the years 2005-2010). A control group of 1360 women was used for comparison. Multivariable unconditional logistic regression was conducted to identify potential risk factors for MI in pregnancy and calculate adjusted odds ratios with 95% confidence intervals.
Twenty-five cases of MI in pregnancy were reported, giving an estimated incidence of 0.7 per 100,000 maternities (95%CI 0.5-1.1). Maternal age, smoking, hypertension, twin pregnancy and pre-eclampsia were independently associated with MI in pregnancy. Fifteen (60%) women underwent coronary angiography; nine (60%) had coronary atherosclerosis, three (21%) had coronary artery dissection, one (7%) had a coronary thrombus and two (13%) had normal coronary arteries. Nine women had angioplasty +/- stenting and two were thrombolysed. No women died.
Many risk factors are both recognisable and modifiable. Management of MI in pregnancy was highly variable indicating a clear need for further information regarding the safety and outcomes of different interventions. The addition of pregnancy status as a compulsory field in cardiac audit databases would enable routine collection of this information.
在发达国家，心脏疾病是导致产妇死亡的主要原因之一，占英国所有产妇死亡人数的五分之一。本研究旨在估计英国妊娠和产后一周内心肌梗死（MI）的发病率，并描述其危险因素、处理方法和结局。
采用前瞻性基于人群的研究，对嵌套病例对照分析，使用英国产科监测系统识别英国所有妊娠期间发生 MI 的妇女（2005-2010 年）。选择 1360 名妇女作为对照组进行比较。采用多变量非条件逻辑回归分析识别妊娠期间 MI 的潜在危险因素，并计算调整后的优势比及其 95%置信区间。
报告了 25 例妊娠期间 MI，估计发病率为 0.7/10 万分娩（95%CI 0.5-1.1）。产妇年龄、吸烟、高血压、双胞胎妊娠和子痫前期与妊娠期间 MI 独立相关。15 名（60%）妇女接受了冠状动脉造影检查；9 名（60%）患有冠状动脉粥样硬化，3 名（21%）患有冠状动脉夹层，1 名（7%）患有冠状动脉血栓形成，2 名（13%）有正常冠状动脉。9 名妇女接受了经皮冠状动脉介入治疗 +/-支架置入，2 名妇女接受了溶栓治疗。无妇女死亡。
许多危险因素是可识别和可改变的。妊娠期间 MI 的处理方法差异很大，这表明需要进一步了解不同干预措施的安全性和结局。在心脏检查数据库中增加妊娠状态作为强制性字段，可以实现此类信息的常规收集。
