Badui E, Enciso R
Division of Cardiology, Hospital de Especialidades Centro Medico, La Raza, Mexico, D.F.
Angiology. 1996 Aug;47(8):739-56. doi: 10.1177/000331979604700801.
The purpose of this review is to analyze the possible parameters that lead to the development of what is a rare event--acute myocardial infarction (AMI) during pregnancy and puerperium. Through the Index Médicus, 109 publications on the subject were obtained. Since the first well-documented case by Katz in 1922, 136 patients have been reported, and from these reports the following data have been gathered: the average age was 32.1 years. This event is more frequent during the third trimester and puerperium of the first and second pregnancies. In 42.6% of the patients no coronary risk factors were observed, but when present, hypertension and cigarette smoking were the most common. The anterior wall along or in combination with any other anatomic area was affected in 73% of cases. Coronary angiograms, when taken, appeared normal in 47%. The maternal mortality rate was 26/136 (19.1%) and was higher during the third trimester, labor, and puerperium. Eight patients (8/26) (30.7%) had sudden death. In 5 of these, (62.5%) coronary thrombosis was found. In 18/26 deaths, an autopsy was performed; 9/18 (50%) had coronary thrombus formation and in 7/18 (39%) variable degrees of atherosclerosis were detected. On the other hand, the fetal mortality rate was 16.9%; however, in only 52% was death coincidental with that of the mother. Coronary artery spasm associated with a probable hypercoagulability state was the most likely mechanism in the majority of these patients, followed by atherosclerotic heart disease and coronary dissection-the last being secondary most likely to hormonal changes. During the AMI these patients should be studied by a medical team composed of a cardiologist, gynecologist, and anesthesiologist. A complete cardiologic work-up should be made to decide individually about further pregnancies.
本综述的目的是分析导致妊娠期和产褥期发生罕见事件——急性心肌梗死（AMI）的可能参数。通过医学索引，获得了109篇关于该主题的出版物。自1922年卡茨首次记录的病例以来，已报告了136例患者，并从这些报告中收集了以下数据：平均年龄为32.1岁。该事件在初孕和二孕的晚期及产褥期更为常见。42.6%的患者未观察到冠状动脉危险因素，但如有，则高血压和吸烟最为常见。73%的病例中前壁单独或与其他任何解剖区域联合受累。进行冠状动脉造影时，47%显示正常。孕产妇死亡率为26/136（19.1%），在晚期、分娩期和产褥期更高。8例患者（8/26）（30.7%）猝死。其中5例（62.5%）发现冠状动脉血栓形成。26例死亡中有18例进行了尸检；9/18（50%）有冠状动脉血栓形成，7/18（39%）检测到不同程度的动脉粥样硬化。另一方面，胎儿死亡率为16.9%；然而，只有52%的胎儿死亡与母亲的死亡同时发生。与可能的高凝状态相关的冠状动脉痉挛是这些患者中大多数最可能的机制，其次是动脉粥样硬化性心脏病和冠状动脉夹层——后者最可能继发于激素变化。在发生AMI期间，应由心脏病专家、妇科医生和麻醉医生组成的医疗团队对这些患者进行研究。应进行全面的心脏病检查，以便就进一步妊娠做出个体化决定。
