Impact of Gestational Complications on Severity and Outcomes Following Acute Coronary Syndrome

Abstract

Women who experienced gestational diabetes (GDM) and/or hypertensive disorders of pregnancy (HDP) have approximately twice the risk of cardiovascular disease (CVD) compared with women with normal pregnancy. However, the impact of GDM or HDP at the time of acute coronary syndrome (ACS) is unknown. The aim of this study is to assess the impact of prior pregnancy complications on clinical presentation, severity and major adverse cardiovascular outcomes (MACE) in women with premature ACS (<55 years old). GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-PRemature Acute Coronary SYndrome) is a multicentre, prospective cohort study (January 2009 to April 2013) of young adults (<55 years old) hospitalized with ACS. The current study included parous women. Pregnancy history was collected through self-reported questionnaires at study entry. Outcomes assessed were clinical severity using the GRACE score, (a validated score to predict in-hospital and long-term mortality or reinfarction after ACS), and MACE, including recurrent ACS, revascularization procedures, and cardiac mortality 12 months post-ACS. Multivariate logistic regression models were used to estimate the risk of each outcome due to pregnancy complications. A total of 392 women were enrolled in the study; 310 of them reported prior pregnancies and were divided into 3 groups: 215 prior normal pregnancies, 36 with prior GDM and 76 with prior HDP (33 preeclampsia and 43 gestational hypertension). The mean age was 48.6 +/- 5.6 years. Women with prior HDP were younger (46.4 +/- 6.5 years) than the normal group (49.1 +/- 5.6 years). Women with prior pregnancy complications were more likely to be obese (35.9% vs. 56.0%, p=0.001), to have diabetes (37.9% vs. 14.4%, p<0.001) and chronic hypertension (80.0% vs. 42.3%, p<0.001). The clinical severity of ACS measured by the Grace score was similar in all 3 groups (72.7 vs. 69.1 vs. 69.6, p=0.227 for all comparisons). The occurrence of MACE (8.5% vs. 8.9%, p=0.919) was also similar in all groups, with the exception of recurrent ACS, which was more common in women with prior HDP than women with prior normal pregnancy (adjusted hazard ratio 3.21 +/- 1,79 vs. 0.33 +/- 0.21). The association appeared to be mediated by hypertension. Women with prior pregnancy complications have more CVD risk factors at the time of a premature ACS, and are younger at time of event than are women with prior normal pregnancy. Moreover, women with prior preeclampsia are more likely to experience a recurrent ACS at 12 months.