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Long-Term Outcome Following Coronary Artery Stenting by History of Preterm Delivery
Moa Pehrson1, Andreas Edsfeldt2,3,4, Giovanna Sarno5
1Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Insights
A history of preterm delivery increases the risk of major adverse cardiovascular events (MACE) and mortality in women after coronary stenting. This finding highlights preterm delivery history as a crucial factor in cardiovascular risk assessment for women.
Area of Science:
- Cardiovascular Medicine
- Obstetrics & Gynecology
- Public Health
Background:
- Women face higher risks of major adverse cardiovascular events (MACE) post-percutaneous coronary intervention compared to men.
- Preterm delivery history is a known female-specific risk factor for coronary artery disease, but its impact post-intervention is unclear.
Purpose of the Study:
- To investigate the association between a history of preterm delivery and MACE after initial coronary artery stenting in women.
- To analyze mortality risks associated with preterm delivery history in this patient cohort.
Main Methods:
- A nationwide cohort of 5,766 Swedish women (≤65 years) undergoing their first coronary stent (2006-2017) was analyzed.
- Proportional hazards regression was used to adjust for confounders and assess the link between preterm delivery history and MACE (>30 days post-stenting).
Main Results:
- Over a median 3.7-year follow-up, 20.8% of women experienced MACE. A history of preterm delivery (16.7% of cohort) was linked to increased MACE risk (aHR 1.19) and mortality (aHR 1.38).
- These associations persisted even after excluding women with pregnancy-related hypertensive disorders or diabetes.
- Early preterm delivery showed a lower MACE risk compared to late preterm delivery.
Conclusions:
- A history of preterm delivery is associated with poorer outcomes, including higher MACE and mortality, after first-time coronary stenting in women.
- Preterm delivery history should be considered a significant risk factor in the secondary prevention of cardiovascular disease in women.
Background:
Women are at a greater risk of a major adverse cardiovascular event (MACE) after percutaneous coronary intervention than men. A history of preterm delivery is a female-specific risk factor for coronary artery disease, but its relevance in the treatment of coronary artery disease is unknown.
Objectives:
The purpose of this study was to analyze the association between a history of preterm delivery and MACE after the first coronary artery stenting.
Methods:
We included a nationwide sample of 5,766 Swedish women aged ≤65 years receiving their first coronary stent during 2006 to 2017. To adjust for periprocedural characteristics and estimate the association between a history of preterm delivery and MACE at >30 days from stenting, we used proportional hazards regression. We also investigated mortality by history of preterm delivery.
Results:
During a median follow-up time of 3.7 years (IQR: 1.3-6.7 years), 1,200 (20.8%) women had a MACE. In total, 963 (16.7%) women had a history of preterm delivery. A history of preterm delivery was associated with a higher risk of MACE (adjusted HR: 1.19; 95% CI: 1.03-1.38) and mortality (adjusted HR ratio: 1.38; 95% CI: 1.02-1.85). Similar associations were observed when excluding women with a history of hypertensive disorders of pregnancy or diabetes. Subgroup analyses suggested that women with a history of early preterm delivery had lower risk of MACE than those who had late preterm delivery (P = 0.04).
Conclusions:
History of preterm delivery is associated with worse prognosis following the first coronary artery stenting in women and warrants consideration as a risk factor also in the secondary prevention setting.
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