Roth A, Elkayam U
Tel-Aviv Medical Center, Israel.
Ann Intern Med. 1996 Nov 1;125(9):751-62. doi: 10.7326/0003-4819-125-9-199611010-00009.
To review available information on the epidemiology, cause, diagnosis, prognosis, and treatment of acute myocardial infarction during pregnancy or in the early postpartum period and to develop guidelines for the management of this condition.
MEDLINE and Index Medicus searches and a manual search of bibliographies from reviewed articles.
Published reports of well-documented acute myocardial infarction during pregnancy or the early postpartum period or potentially relevant information.
125 well-documented cases of myocardial infarction were identified.
The highest incidence seems to occur in the third trimester and in multigravidas older than 33 years of age. Acute myocardial infarction during pregnancy is most commonly located in the anterior wall. The maternal death rate was 21%; death occurred most often at the time of acute myocardial infarction or within 2 weeks of the infarction and was usually related to labor and delivery. Most fetal deaths were associated with maternal deaths. Coronary artery morphology was studied in 54% of described patients. Coronary atherosclerosis with or without intracoronary thrombus was found in 43% of patients, coronary thrombus without atherosclerotic disease in 21%, coronary dissection in 16%, and normal coronary arteries in 29%.
Acute myocardial infarction during pregnancy or the early postpartum period is rare but may be associated with high risk. Although atherosclerosis can be documented in many cases, coronary dissection and arteries that are normal on angiography are common, especially in acute myocardial infarction occurring in the peripartum or postpartum period. Early diagnosis is often hindered by the normal changes of pregnancy and low level of suspicion. Management should follow the usual principles of care for acute myocardial infarction. However, selection of diagnostic and therapeutic approaches may be greatly influenced by fetal safety.
回顾关于妊娠期或产后早期急性心肌梗死的流行病学、病因、诊断、预后及治疗的现有信息，并制定该疾病的管理指南。
检索MEDLINE和《医学索引》，并手动检索综述文章的参考文献。
已发表的关于妊娠期或产后早期记录充分的急性心肌梗死报告或潜在相关信息。
确定了125例记录充分的心肌梗死病例。
最高发病率似乎出现在孕晚期及年龄大于33岁的多产妇中。妊娠期急性心肌梗死最常见于前壁。孕产妇死亡率为21%；死亡最常发生在急性心肌梗死时或梗死后2周内，通常与分娩有关。大多数胎儿死亡与孕产妇死亡相关。在所描述患者中的54%研究了冠状动脉形态。43%的患者发现有或无冠状动脉内血栓的冠状动脉粥样硬化，21%的患者发现无动脉粥样硬化疾病的冠状动脉血栓，16%的患者发现冠状动脉夹层，29%的患者冠状动脉正常。
妊娠期或产后早期急性心肌梗死罕见，但可能与高风险相关。尽管在许多病例中可记录到动脉粥样硬化，但冠状动脉夹层和血管造影正常的动脉很常见，尤其是在围产期或产后发生的急性心肌梗死中。早期诊断常因妊娠的正常变化和低怀疑度而受阻。管理应遵循急性心肌梗死的常规护理原则。然而，诊断和治疗方法的选择可能会受到胎儿安全的极大影响。
