Grand'Maison Sophie, Pilote Louise, Schlosser Kenny, Stewart Duncan J, Okano Marisa, Dayan Natalie
Division of General Internal Medicine, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada.
Research Institute, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Can J Cardiol. 2017 Dec;33(12):1683-1692. doi: 10.1016/j.cjca.2017.08.025. Epub 2017 Sep 11.
Women with previous cardiometabolic complications of pregnancy experience double the risk of cardiovascular disease. However, few data exist on the clinical effect of these complications at the time of an acute coronary syndrome (ACS). The objective of this work was to compare risk factors, clinical features, and outcomes among women with premature ACS with or without previous pregnancy complications (gestational diabetes and/or hypertensive disorders of pregnancy).
Data were obtained from a multicentre cohort of individuals hospitalized with premature ACS. A total of 251 parous women were included and provided obstetric history and blood samples. They were followed for the development of major adverse cardiac events at 12 months.
At presentation with ACS, women with a previous pregnancy complication (38%) were slightly younger than were women without such complications (47.4 ± 6.2 vs 49.1 ± 5.6 years; P = 0.002). They also had more traditional atherosclerotic risk factors. Specifically, women with previous preeclampsia were more likely to have chronic hypertension and an elevated ratio of soluble fms-like tyrosine kinase:placental growth factor. There was no between-group difference in Global Registry of Acute Coronary Events (GRACE) score or troponin tertile but there was a trend toward higher risk of ST-elevation myocardial infarction in women who had a previous pregnancy complication (odds ratio, 1.80; 95% confidence interval, 1.00-3.23; P = 0.05). There was also an increased risk of recurrent ACS at 12 months in women with previous preeclampsia (hazard ratio, 6.79; 95% confidence interval, 1.37-33.63; P = 0.02).
Among a cohort of women with ACS, previous pregnancy complications were associated with more severe disease and poorer outcome.
既往有妊娠心脏代谢并发症的女性患心血管疾病的风险会增加一倍。然而，关于这些并发症在急性冠状动脉综合征（ACS）发生时的临床影响的数据却很少。这项研究的目的是比较有或没有既往妊娠并发症（妊娠期糖尿病和/或妊娠高血压疾病）的过早发生ACS的女性之间的危险因素、临床特征和预后。
数据来自一个多中心队列中因过早发生ACS而住院的个体。总共纳入了251名经产妇，她们提供了产科病史并采集了血样。对她们进行了为期12个月的主要不良心脏事件发生情况的随访。
在出现ACS时，有既往妊娠并发症的女性（38%）比没有此类并发症的女性略年轻（47.4±6.2岁对49.1±5.6岁；P=0.002）。她们也有更多传统的动脉粥样硬化危险因素。具体而言，既往有子痫前期的女性更有可能患有慢性高血压，且可溶性fms样酪氨酸激酶与胎盘生长因子的比值升高。在急性冠状动脉事件全球注册（GRACE）评分或肌钙蛋白三分位数方面，两组之间没有差异，但既往有妊娠并发症的女性发生ST段抬高型心肌梗死的风险有升高趋势（比值比，1.80；95%置信区间，1.00-3.23；P=0.05）。既往有子痫前期的女性在12个月时发生复发性ACS的风险也增加（风险比，6.79；95%置信区间，1.37-33.63；P=0.02）。
在一组患有ACS的女性中，既往妊娠并发症与更严重的疾病和更差的预后相关。
