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Pregnancy-Associated Myocardial Infarction: A Review of Current Practices and Guidelines

  • Management of Acute Coronary Syndromes (H Jneid, Section Editor)
  • Published:
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Abstract

Purpose of Review

Pregnancy-associated myocardial infarction is a principal cause of cardiovascular disease with a steadily rising incidence of 4.98 AMI events/100,000 deliveries over the last four decades in the USA. It is also linked with significant maternal and fetal morbidity and mortality, with maternal case fatality rate ranging from 5.1 to 37%. The management of acute myocardial infarction can be challenging in pregnant patients since treatment modalities and medication use are limited by their safety during pregnancy.

Recent Findings

Limited guidelines exist regarding the management of pregnancy-associated myocardial infarction. Routinely used medications in myocardial infarction including angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and statin therapy are contraindicated during pregnancy. Aspirin use is considered safe in pregnant women, but dual antiplatelet therapy and therapeutic anticoagulation can be associated with increased risk of maternal and fetal complications, and should only be used after a comprehensive benefit-to-risk assessment. The standard approach to revascularization requires additional caution in pregnant women. Percutaneous coronary intervention is generally considered safe but can be associated with high failure rates and poor outcomes depending on the etiology. Fibrinolytic therapy may have significant sequelae in pregnant patients, and hemodynamic management during surgery is complex and adds risk during pregnancy.

Summary

Understanding the risks and benefits of the different treatment modalities available and their utility depending on the underlying etiology, encompassed with a multidisciplinary team approach, is vital to improve outcomes and minimize maternal and fetal complications.

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Author notes

  1. Leslie Cho and Ankur Kalra contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA

    Anas Alameh

  2. Heart and Vascular Center, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH, USA

    Ahmad Jabri, Farhan Nasser & Meera Kondapaneni

  3. Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

    Wesam Aleyadeh

  4. Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD, USA

    Ahmad Al Abdouh

  5. Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, USA

    Martha Gulati

  6. Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA

    Deirdre Mattina, Umesh N. Khot, Leslie Cho & Ankur Kalra

  7. Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA

    Katherine Singh

  8. Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA

    Jennifer Hargrave

  9. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA

    Eric E. Roselli

  10. Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA

    Ankur Kalra

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Alameh, A., Jabri, A., Aleyadeh, W. et al. Pregnancy-Associated Myocardial Infarction: A Review of Current Practices and Guidelines. Curr Cardiol Rep 23, 142 (2021). https://doi.org/10.1007/s11886-021-01579-z

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