(326) Risk factors for myocardial infarction and coronary artery dissection in pregnancy and postpartum

Retrospective case-control study of pregnant and postpartum subjects from the National Inpatient Sample database through HCUP/AHRQ from 2017-2021 using inpatient ICD-10 coding, encompassing antepartum, delivery, and postpartum admissions. We first identified the incidence of MI/CAD from 2017 to 2021 and compared the baseline characteristics of those who experienced MI/CAD to those who did not. Chi2 analysis and student’s t-tests were used for comparison. A backwards regression was used to analyze the impact of individual patient characteristics and history on likelihood of MI/CAD.


Results: Over the 5 year period, a total of 1,159 pregnant subjects had an MI or CAD (0.03%). The incidence increased from 2017 to 2021 (0.027% to 0.034%, p=0.036). Those who experienced MI/CAD were more likely to be older, publicly insured, in the lowest income bracket, and identify as non-Hispanic black.  They were also more likely to be obese, use tobacco, have pre-gestational diabetes and experience a hypertensive disorder of pregnancy, in particular preeclampsia with severe features, superimposed preeclampsia, and HELLP or eclampsia. In regression analysis, age, non-Hispanic black race, obesity, tobacco use, DM, hypertensive disorders of pregnancy, public insurance or self-pay, and the lowest income quartile remained associated with MI/CAD in the pregnant and postpartum period.

Conclusion: The incidence of MI/CAD in the peripartum period increased steadily from 2017 to 2021. This increase was associated with identifiable risk factors including age, non-Hispanic black race, obesity, tobacco use, DM, hypertensive disorders of pregnancy, public insurance or self-pay, and the lowest income quartile.