Perinatal and Cardiovascular Epidemiology Lund University Diabetes Centre, Clinical Sciences Malmö, Lund University Malmö Sweden.
Department of Medical Sciences Cardiology and Uppsala Clinical Research Center, Uppsala University Uppsala Sweden.
J Am Heart Assoc. 2022 Sep 20;11(18):e026287. doi: 10.1161/JAHA.122.026287. Epub 2022 Sep 8.
Background A history of preeclampsia is associated with increased risk of coronary artery disease and experimental evidence suggests that a history of preeclampsia also increases the risk of restenosis. However, the extent to which a history of preeclampsia is associated with risk of restenosis after percutaneous coronary intervention in women is unknown. Methods and Results We included 6065 parous women aged ≤65 years with first percutaneous coronary intervention on 9452 segments 2006 to 2017, linking nationwide data on percutaneous coronary intervention and delivery history in Sweden. Main outcomes were clinical restenosis and target lesion revascularization within 2 years. We accounted for segment-, procedure-, and patient-related potential predictors of restenosis in proportional hazards regression models. Restenosis occurred in 345 segments (3.7%) and target lesion revascularization was performed on 383 patients (6.3%). A history of preeclampsia was neither significantly associated with risk of restenosis (predictor-accounted hazard ratio [HR], 0.71 [95% CI, 0.41-1.23]) nor target lesion revascularization (0.74 [95% CI, 0.51-1.07]) compared with a normotensive pregnancy history. When term and preterm preeclampsia were investigated separately, segments in women with a history of term preeclampsia had a lower risk of restenosis (predictor-accounted HR, 0.45 [95% CI, 0.21-0.94]). A history of preeclampsia was not significantly associated with death by any cause within 2 years of the index procedure (predictor-accounted HR 1.06, [95% CI, 0.62-1.80]). Conclusions A history of preeclampsia was not associated with increased risk of restenosis but instead some evidence pointed to a decreased risk. To facilitate future studies and allow for replication, concomitant collection of data on pregnancy complication history and percutaneous coronary intervention outcomes in women is warranted.
子痫前期病史与冠状动脉疾病风险增加相关，实验证据表明，子痫前期病史也会增加再狭窄的风险。然而，子痫前期病史与女性经皮冠状动脉介入治疗后再狭窄风险之间的关系尚不清楚。
我们纳入了 2006 年至 2017 年在瑞典接受首次经皮冠状动脉介入治疗的 9452 个节段中 6065 名≤65 岁的经产妇，通过全国性数据链接了经皮冠状动脉介入治疗和分娩史。主要结局是 2 年内临床再狭窄和靶病变血运重建。我们在比例风险回归模型中考虑了节段、手术和患者相关的再狭窄潜在预测因素。345 个节段（3.7%）发生再狭窄，383 例患者（6.3%）接受了靶病变血运重建。与正常妊娠史相比，子痫前期病史与再狭窄风险（预测因素校正后的危险比[HR]，0.71[95%CI，0.41-1.23]）或靶病变血运重建（0.74[95%CI，0.51-1.07]）均无显著相关性。当分别研究足月和早产子痫前期时，患有足月子痫前期病史的患者节段再狭窄风险较低（预测因素校正后的 HR，0.45[95%CI，0.21-0.94]）。在指数操作后 2 年内，子痫前期病史与任何原因导致的死亡均无显著相关性（预测因素校正后的 HR 1.06[95%CI，0.62-1.80]）。
子痫前期病史与再狭窄风险增加无关，但有一些证据表明再狭窄风险降低。为了促进未来的研究并允许复制，有必要同时收集女性妊娠并发症史和经皮冠状动脉介入治疗结局的数据。
