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. 2025 Jan 8;4(2):101554.
doi: 10.1016/j.jacadv.2024.101554. eCollection 2025 Feb.

Pregnancy-Associated Myocardial Infarction in Alberta: A Population-Based Study

Paul S Gibson  1 , Angela J Kealey  2 , Katherine E Steckham  3 , Jonathan D Windram  4 , Amy Metcalfe  5 , Michelle M Graham  4
Affiliations

Pregnancy-Associated Myocardial Infarction in Alberta: A Population-Based Study

Paul S Gibson et al. JACC Adv. .

Abstract

Background: Cardiac disease is the leading cause of maternal mortality in developed countries, and myocardial infarction (MI) is an important cause of pregnancy-associated morbidity and mortality. These infrequent, but very serious, events are not optimally described in the medical literature.

Objectives: This study describes a 15-year consecutive, retrospective cohort of confirmed pregnancy-associated MIs (PAMIs) identified in Alberta, Canada (2003-2017).

Methods: Utilizing a provincial administrative database, a cohort of women with PAMI were identified using a validated algorithm. Additional cases were identified by reviewing provincial maternal mortality records. Medical record review was conducted on each case with further details obtained via linkage with a provincial coronary heart disease registry. Available angiographic images were also reviewed.

Results: Forty-three cases of PAMI were identified in Alberta between 2003 and 2017, providing a crude incidence of ∼5.64/100,000 births. Rates of PAMI increased over the study period. Of the identified MIs, 16.3% occurred antepartum (mean gestational age of 18 weeks), while 30.2% were peripartum and 53.4% occurred within 6 months postpartum (at a mean of 7.8 weeks after delivery). The most common mechanism of PAMI was spontaneous coronary artery dissection (44.2%) and this mechanism predominated postpartum. Coronary artery disease was a frequent antepartum cause of MI, whereas demand ischemia was the leading cause of peripartum MI. Maternal mortality was approximately 9%.

Conclusions: PAMI is an increasing cause of maternal morbidity and mortality in Alberta. Clinicians should have a high index of suspicion for PAMI and ensure optimal management of this dangerous complication of pregnancy.

Keywords: angiography; database; mortality; myocardial infarction; pregnancy.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Timing of Pregnancy-Associated Myocardial Infarction This figure illustrates the number of pregnancy-associated myocardial infarctions which occurred in each period of study (antepartum, peripartum, or postpartum) and their relative frequency (proportion of total myocardial infarctions).
Figure 2
Figure 2
Mechanism of Pregnancy-Associated Myocardial Infarction This figure illustrates the various mechanism of pregnancy-associated myocardial infarction identified in the study population (spontaneous coronary dissection, coronary artery disease, demand ischemia, coronary embolism, aortic dissection, coronary thrombosis, and normal coronaries), as well as their relative frequency (proportion of total causes of myocardial infarction). SCAD = spontaneous coronary artery dissection; CAD = atherosclerotic coronary artery disease.
Central Illustration
Central Illustration
Pregnancy-Associated Myocardial Infarction in Alberta, Canada, 2003 to 2017 Causes of pregnancy-associated myocardial infarction identified in this study.
See this image and copyright information in PMC

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