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Cardiovascular Outcomes After Preeclampsia or Eclampsia Complicated by Myocardial Infarction or Stroke

Gastrich, Mary Downes PhD, EDD; Gandhi, Sampada K. MBBS, MPH; Pantazopoulos, John MD; Zang, Edith A. PhD; Cosgrove, Nora M. RN; Cabrera, Javier PhD; Sedjro, Jeanine E. MS; Bachmann, Gloria MD; Kostis, John B. MD

doi: 10.1097/AOG.0b013e31826ae78a
Original Research

OBJECTIVE: To assess the relationship between preeclampsia or eclampsia and stroke, myocardial infarction (MI), subsequent cardiovascular outcomes, and long-term survival.

METHODS: Using the Myocardial Infarction Data Acquisition System in New Jersey (1994–2009), we analyzed cardiovascular outcomes in women with and without preeclampsia or eclampsia and a first MI or stroke but with a hospitalization for a first MI or stroke (analysis 1: MI case group, n=57; MI control group, n=155; stroke case group, n=132; stroke control group, n=379). We also compared these outcomes in women with preeclampsia or eclampsia and a first MI or stroke during pregnancy with women with preeclampsia or eclampsia without MI or stroke during pregnancy (analysis 2: MI case group, n=23; MI control group, n=67; stroke case group, n=90; stroke control group, n=263). A subsequent occurrence of MI, stroke, and cardiovascular death, as well as a combined cardiovascular outcome, was ascertained.

RESULTS: In analysis 1, women with preeclampsia or eclampsia were at significantly lower risk for combined cardiovascular outcome with all deaths (frequency of outcome 16.7%) and with cardiovascular deaths (10.6%) compared with women without preeclampsia or eclampsia after a first stroke (33.8% and 23.5%, respectively). In analysis 2, women with preeclampsia or eclampsia and a first stroke during admission were at significantly higher risk of all death (11.1%) and the combined cardiovascular outcome with all deaths (11.1%) compared with women with preeclampsia or eclampsia without a stroke (1.9% and 2.7%, respectively) during that admission.

CONCLUSION: Our study indicates that preeclampsia or eclampsia not complicated by MI or stroke during pregnancy may not confer a very high risk for subsequent MI and stroke in up to 16 years of follow-up. Our data suggest that other known risk factors put women at greater risk for stroke than preeclampsia or eclampsia complicated by a stroke.

LEVEL OF EVIDENCE: II

Women with preeclampsia who are without stroke on admission have the lowest risk of adverse cardiovascular outcomes.

From the Department of Obstetrics/Gynecology and Reproductive Sciences and the Cardiovascular Institute, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey; Rutgers University, Piscataway, New Jersey.

The Myocardial Infarction Data Acquisition System was supported by Robert Wood Johnson Foundation, Princeton, New Jersey, and ID 57787 by Schering Plough Foundation, Kenilworth, New Jersey.

Corresponding author: Mary D. Gastrich, PhD, EDD, Department of Obstetrics and Gynecology and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, CAB Room 2105, New Brunswick, NJ 08901; e-mail: gastrimd@umdnj.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2012 The American College of Obstetricians and Gynecologists