Percutaneous coronary intervention outcomes in patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis

Abstract

Objective Patients with autoimmune rheumatic disease (AIRD) are at an increased risk of coronary artery disease. The present study sought to examine the prevalence and outcomes of AIRD patients undergoing percutaneous coronary intervention (PCI) from a national perspective. Methods All PCI-related hospitalizations recorded in the US National Inpatient Sample (2004–2014) were included, stratified into four groups: no AIRD, RA, SLE and SSc. We examined the prevalence of AIRD subtypes and assessed their association with in-hospital adverse events using multivariable logistic regression [odds ratios (OR) (95% CI)]. Results Patients with AIRD represented 1.4% (n = 90 469) of PCI hospitalizations. The prevalence of RA increased from 0.8% in 2004 to 1.4% in 2014, but other AIRD subtypes remained stable. In multivariable analysis, the adjusted odds ratio (aOR) of in-hospital complications [aOR any complication 1.13 (95% CI 1.01, 1.26), all-cause mortality 1.32 (1.03, 1.71), bleeding 1.50 (1.30, 1.74), stroke 1.36 (1.14, 1.62)] were significantly higher in patients with SSc compared with those without AIRD. There was no difference in complications between the SLE and RA groups and those without AIRD, except higher odds of bleeding in SLE patients [aOR 1.19 (95% CI 1.09, 1.29)] and reduced odds of all-cause mortality in RA patients [aOR 0.79 (95% CI 0.70, 0.88)]. Conclusion In a nationwide cohort of US hospitalizations, we demonstrate increased rates of all adverse clinical outcomes following PCI in people with SSc and increased bleeding in SLE. Management of such patients should involve a multiteam approach with rheumatologists.

Long‐term outcomes of patients with chronic inflammatory diseases after percutaneous coronary intervention

“…Previous studies found in patients with AIRD increased post‐PCI short‐term mortality 6–8 . Our result presents a clear trend (however failed to reach statistical significance) of increased risk of long‐term mortality.…”

“…This group includes autoimmune rheumatic diseases (AIRD), that is, systemic lupus erythematosus (SLE) and Rheumatoid arthritis (RA) 1,2 and inflammatory bowel diseases (IBD) 3–5 . AIRD patients comprise about 0.8%–1.4% of all patients undergoing percutaneous coronary intervention (PCI), and data regarding outcomes are conflicting 6 . A previous large cohort did not find increased rate of in‐hospital mortality, stroke and bleeding in and RA compared to the non‐AIRD population 6 .…”

“…AIRD patients comprise about 0.8%–1.4% of all patients undergoing percutaneous coronary intervention (PCI), and data regarding outcomes are conflicting 6 . A previous large cohort did not find increased rate of in‐hospital mortality, stroke and bleeding in and RA compared to the non‐AIRD population 6 . However, two other studies found a higher risk for adverse events in RA patients both in‐hospital and during short‐term follow up 7,8 .…”

CHLD score, a new score based on traditional risk factor evaluation and long-term cardiovascular outcomes in patients with systemic sclerosis

“…It is worth to emphasize that patients with SSc have higher rate of acute coronary syndromes, but also their treatment is fraught with higher risk of complications. SSc patients undergoing percutaneous coronary interventions were more likely to exhibit in-hospital complications than patients without connective tissue disorders, with much more higher in-hospital all-cause mortality (OR 1.32, 95%CI 1.03–1.71) 16 .…”

Outcomes of Percutaneous Coronary Intervention in Patients With Crohn's Disease and Ulcerative Colitis (from a Nationwide Cohort)

“…[7][8][9][10] Despite previous reports of worse PCI-related outcomes with some chronic inflammatory conditions, there is limited evidence on procedural outcomes of PCI in patients with IBD. [11][12][13][14][15] we examined the prevalence of IBD, their clinic a l characteristics and in-hospital outcomes in patients undergoing PCI from a nationa lly representative sample in the United States (US).…”