Changing Incidence and Mechanism of Pregnancy‐Associated Myocardial Infarction in the State of California
Background The objective of this study was to evaluate the temporal trends in pregnancy‐associated myocardial infarction (PAMI) in the State of California and explore potential risk factors and mechanisms. Methods and Results The California State Inpatient Database was analyzed from 2003 to 2011 for...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.021056 |
| _version_ | 1797884424745910272 |
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| author | Sawan Jalnapurkar Karen Huaying Xu Zhiwei Zhang C. Noel Bairey Merz Uri Elkayam Ramdas G. Pai |
| author_facet | Sawan Jalnapurkar Karen Huaying Xu Zhiwei Zhang C. Noel Bairey Merz Uri Elkayam Ramdas G. Pai |
| author_sort | Sawan Jalnapurkar |
| collection | DOAJ |
| description | Background The objective of this study was to evaluate the temporal trends in pregnancy‐associated myocardial infarction (PAMI) in the State of California and explore potential risk factors and mechanisms. Methods and Results The California State Inpatient Database was analyzed from 2003 to 2011 for patients with International Classification of Diseases, Ninth Revision (ICD‐9) codes for acute myocardial infarction and pregnancy or postpartum admissions; risk factors were analyzed and compared with pregnant patients without myocardial infarction. A total of 341 patients were identified with PAMI from a total of 5 266 380 pregnancies (incidence of 6.5 per 100 000 pregnancies). Inpatient maternal mortality rate was 7%, and infant mortality rate was 3.5% among patients with PAMI. There was a nonsignificant trend toward an increase in PAMI incidence from 2003 to 2011, possibly attributable to higher incidence of spontaneous coronary artery dissection, vasospasm, and Takotsubo syndrome. PAMI, when compared with pregnant patients without myocardial infarction, was significant for older age (aged >30 years in 72% versus 37%, P<0.0005), higher preponderance of Black race (12% versus 6%, P<0.00005), lower socioeconomic status (median household income in lowest quartile 26% versus 20%, P=0.04), higher prevalence of hypertension (26% versus 7%, P<0.0005), diabetes (7% versus 1%, P<0.0005), anemia (31% versus 7%, P<0.0001), amphetamine use (1% versus 0%, P<0.00005), cocaine use (2% versus 0.2%, P<0.0001), and smoking (6% versus 1%, P=0.0001). Conclusions There has been a trend toward an increase in PAMI incidence in California over the past decade, with an increasing trend in spontaneous coronary artery dissection, vasospasm, and Takotsubo syndrome as mechanisms. These findings warrant further investigation. |
| first_indexed | 2024-04-10T04:06:40Z |
| format | Article |
| id | doaj.art-9ccab4a81b6f4f32b6b373df24f9c8f0 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T04:06:40Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-9ccab4a81b6f4f32b6b373df24f9c8f02023-03-13T05:24:49ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-11-01102110.1161/JAHA.121.021056Changing Incidence and Mechanism of Pregnancy‐Associated Myocardial Infarction in the State of CaliforniaSawan Jalnapurkar0Karen Huaying Xu1Zhiwei Zhang2C. Noel Bairey Merz3Uri Elkayam4Ramdas G. Pai5Department of Internal Medicine and Cardiology University of California Riverside School of Medicine Riverside CADepartment of Statistics University of California Riverside Los Angeles CADepartment of Statistics University of California Riverside Los Angeles CADepartment of Cardiology Cedars Sinai Medical Center Los AngelesUniversity of Southern California Los Angeles CADepartment of Internal Medicine and Cardiology University of California Riverside School of Medicine Riverside CABackground The objective of this study was to evaluate the temporal trends in pregnancy‐associated myocardial infarction (PAMI) in the State of California and explore potential risk factors and mechanisms. Methods and Results The California State Inpatient Database was analyzed from 2003 to 2011 for patients with International Classification of Diseases, Ninth Revision (ICD‐9) codes for acute myocardial infarction and pregnancy or postpartum admissions; risk factors were analyzed and compared with pregnant patients without myocardial infarction. A total of 341 patients were identified with PAMI from a total of 5 266 380 pregnancies (incidence of 6.5 per 100 000 pregnancies). Inpatient maternal mortality rate was 7%, and infant mortality rate was 3.5% among patients with PAMI. There was a nonsignificant trend toward an increase in PAMI incidence from 2003 to 2011, possibly attributable to higher incidence of spontaneous coronary artery dissection, vasospasm, and Takotsubo syndrome. PAMI, when compared with pregnant patients without myocardial infarction, was significant for older age (aged >30 years in 72% versus 37%, P<0.0005), higher preponderance of Black race (12% versus 6%, P<0.00005), lower socioeconomic status (median household income in lowest quartile 26% versus 20%, P=0.04), higher prevalence of hypertension (26% versus 7%, P<0.0005), diabetes (7% versus 1%, P<0.0005), anemia (31% versus 7%, P<0.0001), amphetamine use (1% versus 0%, P<0.00005), cocaine use (2% versus 0.2%, P<0.0001), and smoking (6% versus 1%, P=0.0001). Conclusions There has been a trend toward an increase in PAMI incidence in California over the past decade, with an increasing trend in spontaneous coronary artery dissection, vasospasm, and Takotsubo syndrome as mechanisms. These findings warrant further investigation.https://www.ahajournals.org/doi/10.1161/JAHA.121.021056coronary spasmfetal mortalitymaternal mortalitypregnancypregnancy‐associated myocardial infarctionspontaneous coronary artery dissection |
| spellingShingle | Sawan Jalnapurkar Karen Huaying Xu Zhiwei Zhang C. Noel Bairey Merz Uri Elkayam Ramdas G. Pai Changing Incidence and Mechanism of Pregnancy‐Associated Myocardial Infarction in the State of California Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary spasm fetal mortality maternal mortality pregnancy pregnancy‐associated myocardial infarction spontaneous coronary artery dissection |
| title | Changing Incidence and Mechanism of Pregnancy‐Associated Myocardial Infarction in the State of California |
| title_full | Changing Incidence and Mechanism of Pregnancy‐Associated Myocardial Infarction in the State of California |
| title_fullStr | Changing Incidence and Mechanism of Pregnancy‐Associated Myocardial Infarction in the State of California |
| title_full_unstemmed | Changing Incidence and Mechanism of Pregnancy‐Associated Myocardial Infarction in the State of California |
| title_short | Changing Incidence and Mechanism of Pregnancy‐Associated Myocardial Infarction in the State of California |
| title_sort | changing incidence and mechanism of pregnancy associated myocardial infarction in the state of california |
| topic | coronary spasm fetal mortality maternal mortality pregnancy pregnancy‐associated myocardial infarction spontaneous coronary artery dissection |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.021056 |
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