Wu Shengyong, Xu Xudong, He Qian, Qin Yingyi, Wang Rui, Chen Jun, Chen Chenxin, Wu Cheng, Liu Suxuan
Department of Military Health Statistics, Navy Medical University, Shanghai, China.
Department of Cardiology, Changhai Hospital, Navy Medical University, Shanghai, China.
Front Cardiovasc Med. 2022 Aug 11;9:968964. doi: 10.3389/fcvm.2022.968964. eCollection 2022.
To investigate the incidence and outcomes of acute high-risk chest pain diseases, including acute myocardial infarction (AMI), aortic dissection (AD), and pulmonary embolism (PE) during pregnancy and puerperium.
The National Inpatient Sample was queried to identify pregnancy-related hospitalizations from January 1, 2008 to December 31, 2017. Temporal trends in the incidence and mortality of AMI, AD and PE were extracted.
Among 41,174,101 hospitalizations, acute high-risk chest pain diseases were diagnosed in 40,285 (0.098%). The incidence increased from 79.92/100,000 in 2008 to 114.79/100,000 in 2017 (P < 0.0001). The most frequent was PE (86.5%), followed by AMI (9.6%) and AD (3.3%). The incidence of PE in pregnancy decreased after 2014 and was lower than AMI and AD, while its incidence in puerperium was higher than AMI and AD consistently (P < 0.0001). Subgroup analysis showed the incidence of these diseases was higher in black women, lowest-income households, and elderly parturients (P < 0.0001). The mortality decreased from 2.24% in 2008 to 2.21% in 2017 (P = 0.0240), exhibiting 200-fold higher than patients without these diseases. The following factors were significantly associated with these diseases: aged ≥ 45 years (OR, 4.25; 95%CI, 3.80-4.75), valvular disease (OR, 10.20; 95%CI, 9.73-10.70), and metastatic cancer (OR, 9.75; 95%CI, 7.78-12.22). The trend of elderly parturients increased from 14.94% in 2008 to 17.81% in 2017 (P < 0.0001), while no such up-trend was found in valvular disease and metastatic cancer.
The incidence of acute high-risk chest pain diseases, especially PE in puerperium, increased consistently. Although mortality has shown a downward trend, it is still at a high level. We should strengthen monitoring and management of acute high-risk pain diseases in pregnancy and puerperium, especially for black women, lowest-income households, and elderly parturients in the future.
探讨妊娠和产褥期急性高危胸痛疾病的发病率及转归，包括急性心肌梗死（AMI）、主动脉夹层（AD）和肺栓塞（PE）。
查询国家住院患者样本，以确定2008年1月1日至2017年12月31日期间与妊娠相关的住院病例。提取AMI、AD和PE发病率及死亡率的时间趋势。
在41174101例住院病例中，40285例（0.098%）被诊断为急性高危胸痛疾病。发病率从2008年的79.92/10万增至2017年的114.79/10万（P<0.0001）。最常见的是PE（86.5%），其次是AMI（9.6%）和AD（3.3%）。2014年后妊娠期间PE发病率下降，低于AMI和AD，而其产褥期发病率始终高于AMI和AD（P<0.0001）。亚组分析显示，这些疾病在黑人女性、最低收入家庭和高龄产妇中发病率较高（P<0.0001）。死亡率从2008年的2.24%降至2017年的2.21%（P=0.0240），比无这些疾病的患者高200倍。以下因素与这些疾病显著相关：年龄≥45岁（OR，4.25；95%CI，3.80-4.75）、瓣膜病（OR，10.20；95%CI，9.73-10.70）和转移性癌症（OR，9.75；95%CI，7.78-12.22）。高龄产妇比例从2008年的14.94%增至2017年的17.81%（P<0.0001），而瓣膜病和转移性癌症未发现类似上升趋势。
急性高危胸痛疾病发病率持续上升，尤其是产褥期的PE。虽然死亡率呈下降趋势，但仍处于较高水平。未来应加强对妊娠和产褥期急性高危疼痛疾病的监测和管理，尤其是针对黑人女性、最低收入家庭和高龄产妇。
