Clinical Features of Myocardial Infarction in Women With a History of Preeclampsia: A Population-Based Cohort Study

Preeclampsia is associated with an increased lifetime risk of myocardial infarction. This study explored whether there is a difference in the clinical features and severity of myocardial infarction in women with previous preeclampsia compared with women with no history of preeclampsia.

This register-based cohort study combined data from the Swedish Medical Birth Register with data from the quality register the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies. Women with a first singleton birth between 1973 and 2019 were included. The outcome of myocardial infarction was categorized as severe if it resulted in death within 7 days, cardiogenic shock, cardiac arrest, impaired left ventricular systolic function, mechanical complication, or ST-segment-elevation myocardial infarction. The association between preeclampsia and myocardial infarction was investigated using cause-specific hazard models.

Among 1 966 096 women with a first singleton birth, 82 980 (4.2%) had preeclampsia. Myocardial infarction was registered in 10 758 (0.5%) of the total population. One-third (n=3672, 34.1%) of myocardial infarctions had severe features and two-thirds (n=6996, 69.1%) were nonsevere. Preeclampsia was associated with increased risk of myocardial infarction, with an adjusted hazard ratio (HR) of 1.71 (95% CI, 1.50-1.94) for severe and 1.86 (95% CI, 1.71-2.04) for nonsevere myocardial infarction. Myocardial infarction in women with prior preeclampsia compared with women without preeclampsia was associated with a higher risk of death (HR, 3.00 [95% CI, 1.10-8.14]), cardiogenic shock (HR, 1.69 [95% CI, 1.11-2.58]), and impaired left ventricular systolic function (HR, 1.69 [95% CI, 1.11-2.58]), while no association was observed for cardiac arrest (HR, 1.37 [95% CI, 0.98-1.93]), ST-segment-elevation myocardial infarction (HR, 1.01 [95% CI, 0.86-1.18]), or mechanical complication (HR, 0.57 [95% CI, 0.08-4.15]).

Women with a history of preeclampsia have almost twice the risk of myocardial infarction. Myocardial infarction among women with prior preeclampsia more often results in death, cardiogenic shock, and impaired left ventricular systolic function than among women without preeclampsia.