Acute Myocardial Infarction Associated with Pregnancy Successfully Treated with Percutaneous Coronary Intervention

Arimura, Tadaaki; Mitsutake, Ryoko; Miura, Shin‐ichiro; Nishikawa, Hiroaki; Kawamura, Akira; Saku, Keijiro

doi:10.2169/internalmedicine.48.2208

Cited by 18 publications

(18 citation statements)

References 12 publications

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“…Vaginal delivery avoids potential risks associated with anesthesia and a major surgical procedure which include larger blood loss. On the other hand, an elective caesarean section eliminates a long or stressful labor and allows better control of the time of delivery as well as the presence of an appropriate medical team including an experienced obstetrician, obstetric anesthesiologist, cardiologist, and pediatrician [1]. Ultimately, caesarean section was considered as a better alternative in our case.…”

Section: Discussionmentioning

confidence: 89%

“…With such surge in the maternal age, the incidence of cardiovascular events during pregnancy is likely to increase. This may lead to a progressive increase in demand for both preventive and interventional cardiac care among pregnant women in the coming years [1].…”

Section: Discussionmentioning

confidence: 99%

“…Earlier, several cases have been reported on successful PCI during pregnancy and eventual delivery of healthy baby [1] [3] [4]. Arimura et al reported a case of a 43-year-old primiparous woman with acute myocardial infarction, who successfully underwent primary PCI at 21 weeks of gestation and subsequently delivered a healthy baby at 32 weeks gestation upon elective cesarean section [1].…”

Section: Discussionmentioning

confidence: 99%

“…Arimura et al reported a case of a 43-year-old primiparous woman with acute myocardial infarction, who successfully underwent primary PCI at 21 weeks of gestation and subsequently delivered a healthy baby at 32 weeks gestation upon elective cesarean section [1]. Similarly, Sullebarger et al described a case of successful PCI in a 38-year-old pregnant woman with non ST elevation myocardial infarction, who delivered a healthy infant at full term [4].…”

Section: Discussionmentioning

confidence: 99%

“…Myocardial infarction in pregnancy is rare phenomenon, with an estimated frequency of 3 -10 cases per 0.1 million deliveries [1]. The prognosis is often poor as high maternal mortality and fetal loss is frequently associated with pregnancy-related myocardial infarction [2].…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Acute Cerebrovascular Accident in the Post-Partum Period after Primary Angioplasty during Pregnancy

Gupta¹

2015

IJCM

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Pregnancy-related acute myocardial infarction is rare, but a serious event. We report a case of acute myocardial infarction in a 33-year-old female with 5 months of pregnancy. Angiography, under abdominal shield, revealed 100% thrombotic occlusion in the left anterior descending artery, which was treated successfully with a stent implantation. The patient was found to have hyperhomocysteinemia within the first week of primary percutaneous coronary intervention (PCI). Rest of the follow-up was uneventful with delivery of a healthy baby by elective caesarean section at about 36 weeks of gestation. Within 7 days of post-partum period, the patient displayed signs of cerebrovascular infarction and was managed successfully. To the best of our knowledge, the association between primary PCI during pregnancy and cerebrovascular event in the postpartum period has not been reported previously.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Rare Case of Acute Cerebrovascular Accident in the Post-Partum Period after Primary Angioplasty during Pregnancy

Gupta¹

2015

IJCM

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Successful primary percutaneous coronary intervention in the first trimester of pregnancy

Babić

Gabrić

Pintarić

2011

Cathet Cardio Intervent

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A 28-year-old patient, medical nurse, in 10th week of her second pregnancy suffered ventricular fibrillation just after entering the waiting room of the emergency department. After she was successfully defibrillated, electrocardiography revealed a large acute anteroseptolateral ST elevation myocardial infarction. Urgent coronarography was done (premedication with 300 mg of aspirin and 600 mg of clopidogrel) with 90 min door-to-balloon time. Proximal left anterior descending occlusion was found, primary percutaneous coronary intervention was done using Amazonia CroCo 3.0/12 bare-metal stent, and Thrombolysis in Myocardial Infarction III flow was achieved. During the procedure, the patient was wrapped in lead apron. Because of postresuscitational agitation, procedure was done in intravenous anesthesia. The revealed risk factors were smoking and hypercholesterolemia. PAI-1 gene 4G/4G genotype and Apo E gene E2/E4 genotype were also found. Estimated X-ray dosage that fetus received during the procedure was 0.45 mSv, which is less than the upper safe limit in pregnancy. All drugs given to our patient (clopidogrel, aspirin, ivabradine, bisoprolol, anesthetics, low-molecular-weight heparin, and unfractionated heparin) have B or C Food and Drug Administration Pregnancy Category. Fetal ultrasonography showed normal fetal growth, and, after consultation with our team, the patient decided to maintain the pregnancy. Before discharge echocardiography showed left ventricle of normal size with anteroseptolateral hypokinesia, small apical aneurysm, left ventricular ejection fraction of 40-45%, and diastolic dysfunction grade II, without pulmonary hypertension. At the 36th week of pregnancy, the patient was hospitalized and closely monitored; clopidogrel and aspirin were discontinued, and low-molecular-weight heparin was administered. She gave birth to a normal boy by vaginal delivery with epidural anesthesia and without any complication.

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Successful gestation and delivery using clopidogrel for secondary stroke prophylaxis: a case report and literature review

Reilly

Cuesta-Fernandez

Kayaleh

2014

Arch Gynecol Obstet

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Literature is scarce regarding the use of clopidogrel during pregnancy and the potential hazard to maternal and fetal health. We report a 33-year-old female, who presented to our clinic at 40 weeks gestation with a history of multiple prior ischemic strokes and transient ischemic attacks. The patient was placed on clopidogrel for secondary stroke prophylaxis prior to conception and maintained therapy throughout pregnancy without interruption or complication. Clopidogrel was discontinued 7 days prior to induction of labor, and a healthy baby was vaginally delivered without bleeding complications or congenital anomalies. Clopidogrel was restarted 12 hours postpartum without an incident. To our knowledge, this is the first report of clopidogrel use in pregnancy for secondary stroke prophylaxis. We also provide a current review of the literature of the use of clopidogrel in pregnancy. Based on the limited data available, clopidogrel use in pregnancy has not demonstrated significant toxicity to either the mother or the newborn. However, additional studies are needed to further assess the efficacy and safety of this medication in this patient population.

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Acute Myocardial Infarction Associated with Pregnancy Successfully Treated with Percutaneous Coronary Intervention

Abstract: We describe the case of a 43-year-old primiparous woman who had acute myocardial infarction. She underwent successful primary percutaneous coronary intervention. Elective cesarean section was performed uneventfully at 32 weeks gestation.

Cited by 18 publications

References 12 publications

A Rare Case of Acute Cerebrovascular Accident in the Post-Partum Period after Primary Angioplasty during Pregnancy

A Rare Case of Acute Cerebrovascular Accident in the Post-Partum Period after Primary Angioplasty during Pregnancy

Successful primary percutaneous coronary intervention in the first trimester of pregnancy

Successful gestation and delivery using clopidogrel for secondary stroke prophylaxis: a case report and literature review

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