ACUTE CORONARY SYNDROMES DURING PREGNANCY AND POST-PARTUM IN FRANCE, THE NATIONWIDE CONCEPTION STUDY

Abstract

Objective: Very different estimated incidences have been reported concerning pregnancy-related acute coronary syndrome (ACS). The objective of our study was to assess the incidence of ACS during pregnancy, peripartum and postpartum, to compare it with the incidence of ACS in non-pregnant women of childbearing age and to study characteristics associated with pregnancy-related ACS. Design and method: All women without ischemic heart disease who delivered between 2010 and 2018 in France were included in the CONCEPTION cohort. We used Poisson regression to estimate the crude incidence of ACS and age-adjusted Poisson models to estimate the incidence risk ratio (IRR) of ACS in pregnant versus nonpregnant women, with 95% confidence interval (CI). Results: Among 6 298 967 pregnancies in France, 225 experienced a first ever ACS. The global ACS incidence in women giving birth was 4.34 per 100 000 person-years, stable between 2010 and 2018 (1 ACS every 23 000 pregnancies). Compared with nonpregnant women, age-adjusted incidence rates of ACS were lower during pregnancy IRR: 0.76 (95%CI: 0.57–0.98) (p < 0.05). In a multivariate analysis, independent factors associated with ACS were age, social deprivation (OR = 1.91 (1.42–2.58)), obesity (OR = 1.73 (1.13–2.65)), tobacco use (OR = 3.43 (2.55–4.61)) (Table). The risk of ACS associated with chronic hypertension and hypertensive disorders of pregnancy was 4.5 (2.90–6.95) and 2.09 (1.43–3.06) respectively. Conclusions: Global incidence of pregancy-related ACS was 4.34 per 100 000 person-years. The pregnancy-related ACS incidence was 24% lower than the ACS incidence in age-adjusted non-pregnant women. More efforts should be made in terms of prevention, considering the frequency of treatable cardiovascular risk factors such as tobacco use and hypertensive disorders of pregnancy.