Abstract 4141212: Cardiovascular And Obstetrical Outcomes In Women With Premature Coronary Artery Disease

Background: Premature coronary artery disease (CAD) is increasing, especially in young women. There is currently no data regarding the cardiovascular and obstetrical risk of pregnancy in patients with premature CAD. Objective: This study aims to describe the cardiovascular, obstetrical and fetal outcomes in pregnant patients with premature CAD. Methods: Using the AFIJI cohort of individuals with premature CAD (Appraisal of risk Factors in young Ischemic patients Justifying aggressive Intervention), we compared the cardiovascular outcomes of women aged < 40 years-old who experienced pregnancy versus those who did not. Major adverse cardiovascular events (MACE) including death, myocardial infarction, ischemic stroke, or unplanned revascularization were analyzed using a Cox model with pregnancy as a time-dependent variable. A secondary analysis described obstetrical and fetal outcomes in pregnant women with premature CAD vs. pregnant women of the French National maternal and fetal cohort (n=11992). Results: Among women with premature CAD in the AFIJI cohort (N = 120), 50 were aged < 40 years among whom 24 experienced pregnancy. Aspirin was the only treatment continued during pregnancy. We observed an association between pregnancy and an increased risk of cardiovascular events (aHR 3.87, IC95% 1.41-10.63, p < 0.01) adjusted for age and tobacco use. When comparing with the French National database, pregnant women with premature CAD had higher rates of preeclampsia (20.8% vs. 2.3%), pregnancy-induced hypertension (37.5% vs. 2%), threat of premature birth (20.8% vs. 4.8%), postpartum hemorrhage (12.5% vs. 3%) and fetal death (8.7% vs. 0.8%). Conclusion: Pregnancy in women with premature coronary artery disease is associated with a higher risk of major adverse cardiovascular events and significant more obstetrical complications. These findings highlight the need for careful monitoring and management of pregnant patients with a prior history of CAD to mitigate these risks.