Incidence and outcomes of acute high-risk chest pain diseases during pregnancy and puerperium

Shengyong Wu; Xudong Xu; Qian He; Yingyi Qin; Rui Wang; Jun Chen; Chenxin Chen; Cheng Wu; Suxuan Liu

doi:10.3389/fcvm.2022.968964

Incidence and outcomes of acute high-risk chest pain diseases during pregnancy and puerperium

Front Cardiovasc Med. 2022 Aug 11:9:968964. doi: 10.3389/fcvm.2022.968964. eCollection 2022.

Authors

Shengyong Wu¹, Xudong Xu², Qian He¹, Yingyi Qin¹, Rui Wang¹, Jun Chen³, Chenxin Chen¹, Cheng Wu¹, Suxuan Liu²

Affiliations

¹ Department of Military Health Statistics, Navy Medical University, Shanghai, China.
² Department of Cardiology, Changhai Hospital, Navy Medical University, Shanghai, China.
³ Department of Gynecology and Obstetrics, Changhai Hospital, Navy Medical University, Shanghai, China.

Abstract

Aim: To investigate the incidence and outcomes of acute high-risk chest pain diseases, including acute myocardial infarction (AMI), aortic dissection (AD), and pulmonary embolism (PE) during pregnancy and puerperium.

Methods: The National Inpatient Sample was queried to identify pregnancy-related hospitalizations from January 1, 2008 to December 31, 2017. Temporal trends in the incidence and mortality of AMI, AD and PE were extracted.

Results: Among 41,174,101 hospitalizations, acute high-risk chest pain diseases were diagnosed in 40,285 (0.098%). The incidence increased from 79.92/100,000 in 2008 to 114.79/100,000 in 2017 (P_trend < 0.0001). The most frequent was PE (86.5%), followed by AMI (9.6%) and AD (3.3%). The incidence of PE in pregnancy decreased after 2014 and was lower than AMI and AD, while its incidence in puerperium was higher than AMI and AD consistently (P_trend < 0.0001). Subgroup analysis showed the incidence of these diseases was higher in black women, lowest-income households, and elderly parturients (P_trend < 0.0001). The mortality decreased from 2.24% in 2008 to 2.21% in 2017 (P_trend = 0.0240), exhibiting 200-fold higher than patients without these diseases. The following factors were significantly associated with these diseases: aged ≥ 45 years (OR, 4.25; 95%CI, 3.80-4.75), valvular disease (OR, 10.20; 95%CI, 9.73-10.70), and metastatic cancer (OR, 9.75; 95%CI, 7.78-12.22). The trend of elderly parturients increased from 14.94% in 2008 to 17.81% in 2017 (P_trend < 0.0001), while no such up-trend was found in valvular disease and metastatic cancer.

Conclusion: The incidence of acute high-risk chest pain diseases, especially PE in puerperium, increased consistently. Although mortality has shown a downward trend, it is still at a high level. We should strengthen monitoring and management of acute high-risk pain diseases in pregnancy and puerperium, especially for black women, lowest-income households, and elderly parturients in the future.

Keywords: acute myocardial infarction; aortic dissection; pregnancy; puerperium; pulmonary embolism.