Pregnancy-related acute myocardial infarction in Japan.

idemia, are known risk factors for pregnancy-related AMI in Western countries.6,7 In the CMACE report, all the women who died from AMI between 2006 and 2008 in the UK had identifiable risk factors, including obesity, age >35 years, parity >3, smoking, diabetes, pre-existing hypertension, and family history. Therefore, it is recommended that the threshold for further investigation (such as serial ECGs and troponin level) of angina-like symptoms should be low, especially in women with known risk factors. However, the prevalence of conventional risk factors in Japanese women is lower. Instead, many Japanese patients with pregnancy-related AMI received medications such as methylergometrine maleate, ritodrine hydrochloride, and prostaglandin for obstetrical reasons. We need to take care in the use of these medications. In consideration of the risk factors, the etiology of pregnancy-related AMI is also different between Western countries and Japan. Atherosclerotic changes remain the primary cause of pregnancy-related AMI in the West, whereas spontaneous coronary dissection, spasm, and thrombus are the most often cute myocardial infarction (AMI) rarely occurs among women of childbearing age. However, dynamic changes in cardiovascular physiology and coagulation in peripartum can increase the risk of AMI among pregnant women, compared with non-pregnant women of the same age. Moreover, current trends in lifestyle factors, increasing maternal age (Figure 1),1 and fertility are likely to be contributing to this increase in incidence. The United Kingdom (UK) has developed a nationwide system to precisely investigate maternal death (Centre for Maternal and Child Enquiries: CMACE). CMACE reported that cardiovascular disease had been the most frequent cause of indirect maternal death, and ischemic heart disease had now become a common cardiac cause of death in pregnancy.2