ACUTE MYOCARDIAL-INFARCTION ASSOCIATED WITH PREGNANCY

Purpose: To review available information on the epidemiology, cause, d iagnosis, prognosis, and treatment of acute myocardial infarction duri ng pregnancy or in the early postpartum period and to develop guidelin es for the management of this condition. Data Sources: MEDLINE and Ind ex Medicus searches and a manual search of bibliographies from reviewe d articles. Study Selection: Published reports of well-documented acut e myocardial infarction during pregnancy or the early postpartum perio d or potentially relevant information. Data Extraction: 125 well-docum ented cases of myocardial infarction were identified. Data Synthesis: The highest incidence seems to occur in the third trimester and in mul tigravidas older than 33 years of age. Acute myocardial infarction dur ing pregnancy is most commonly located in the anterior wall. The mater nal death rate was 21%; death occurred most often at the time of acute myocardial infarction or within 2 weeks of the infarction and was usu ally 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 intracor onary thrombus was found in 43% of patients, coronary thrombus without atherosclerotic disease in 21%, coronary dissection in 16%, and norma l coronary arteries in 29%. Conclusions: Acute myocardial infarction d uring pregnancy or the early postpartum period is rare but may be asso ciated with high risk. Although atherosclerosis can be documented in m any cases, coronary dissection and arteries that are normal on angiogr aphy are common, especially in acute myocardial infarction occurring i n the peripartum or postpartum period. Early diagnosis is often hinder ed by the normal changes of pregnancy and low level of suspicion. Mana gement should follow the usual principles of care for acute myocardial infarction. However, selection of diagnostic and therapeutic approach es may be greatly influenced by fetal safety.