Objective The objective of this study was to determine outcomes in pregnant women with pre-existing coronary artery disease (CAD) or following an acute coronary syndrome (ACS) including myocardial infarction (MI). Background The physiological changes of pregnancy can contribute to myocardial ischaemia. The pregnancy risk for women with pre-established CAD or a history of ACS/MI is not well studied. Methods This was a retrospective multicentre study. Adverse maternal cardiac, obstetric and fetal/neonatal events were examined. The primary outcome was a composite endpoint of cardiac arrest, ACS/MI, ventricular arrhythmia or congestive heart failure. The prevalence of new or progressive angina during pregnancy was also examined. Results Fifty pregnancies in 43 women (mean age 35 ±5 years) were included. Coronary atherosclerosis (40%) and coronary thrombus (36%) were the most common underlying diagnoses. The primary outcome occurred in 10% (5/50) of pregnancies and included one maternal death secondary to cardiac arrest. Other events included ACS/MI (3/50) and heart failure (1/50). New or progressive angina occurred in 18% of pregnancies. Ischaemic complications of any type (new or progressive angina, ACS/MI, ventricular arrhythmia, cardiac arrest) occurred more commonly in women with coronary atherosclerosis compared with those without (50% vs 10%, p=0.003). A high rate of adverse obstetric (16%) and fetal/neonatal (30%) events was observed. Conclusions Pregnant women with pre-existing CAD or ACS/MI before pregnancy are at increased risk of adverse events during pregnancy. Those with coronary atherosclerosis are at highest risk of adverse maternal cardiac events due to myocardial ischaemia during pregnancy.Current trends have led to an older age at the time of childbirth and increases in the prevalence of maternal diabetes, obesity and hypertension. These factors have contributed to a rising number of women of childbearing age with pre-existing coronary disease.1-3 Ischaemic cardiac events, such as acute myocardial infarction (MI) have been associated with high maternal and fetal mortality. [4][5][6] While early case reports on pregnancy risk in women with pre-existing coronary artery disease (CAD) reported high maternal mortality, 7 subsequent case series reported improved maternal outcomes.8 9 While many women with pre-existing CAD or a history of acute coronary syndrome (ACS) will consider pregnancy, the pregnancy risk for these women is not defined. The objective of this study was to determine maternal and fetal/neonatal outcomes in a large contemporary group of pregnant women with a history of CAD or ACS/MI prior to pregnancy. METHODS Study populationThis was a multicentre review of pregnancies in women seen between 1995 and 2012 at one of the participating centres (University of Toronto, Toronto, Canada; University of British Columbia, Vancouver, Canada; Erasmus University, Rotterdam, The Netherlands; University Medical Centre, Groningen, The Netherlands; Academic Medical Center, Amsterdam, The Netherl...

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