Background Patients with autoimmune diseases (AID) have a high burden of cardiovascular disease leading to premature morbidity and mortality1. But it is unclear if it is due to a higher prevalence of cardiovascular disease, to a worse case fatality or to a different management after an index event.
Objectives The aim of the study is to assess the prevalence of AID in patients with acute coronary syndrome (ACS), the management and prognostic implications.
Methods The study included consecutive patients admitted after ACS from January 2011 to May 2014. For AID patients, in-hospital management and ACS presentation was compared to non-AID patients. We also compared in-hospital and 1-year major adverse events (MACE): death, recurrent myocardial infarction, stroke and major bleeding, between groups. The percentage lost to follow-up was <1%.
Results Of 964 patients, 53 had AID (5.5%): 11 rheumatoid arthritis, 9 inflammatory bowel disease, 7 ankylosing spondylitis, 7 psoriatic arthritis, 5 polymyalgia rheumatica, 4 systemic lupuserythematosus and 10 miscellanea. Mean evolution of the disease was 14±3 years. No significant differences were found in clinical and demographics characteristics between groups except for a higher percentage of previous stable coronary heart disease in non-AID patients. Compared to non-AID patients, AID patients had similar clinical ACS presentation and no differences were found with respect to revascularization strategies or medical treatment at discharge. Overall there were 207 MACE (69% during hospitalization): 108 deaths, 52 recurrent myocardial infarctions, 19 ischemic strokes and 28 major bleedings. The two groups had comparable rates of MACE both during hospitalization (9.6% vs 12.2%, p=0.58) and at 1 year (26.4% vs 19.1%, p=0.19), AID vs non-AID respectively. The presence of AID was not associated with increased in-hospital mortality (OR 1.1, 95% CI 0.4 to 3.3) but it was a risk factor for higher 1-year crude mortality (OR 2.2, 95% CI 1.1 to 4.4), with a trend to higher 1-year mortality after multivariable adjusting (OR 1.7, 95%CI 0.8 to 3.9).
Conclusions The presence of AID did not change ACS presentation and clinical management. Moreover it is not independently associated with worse outcomes during hospitalization although there is a trend to higher 1-year mortality.
Symmons DP, Gabriel SE. Epidemiology of CVD in rheumatic disease, with a focus on RA and SLE. Nat Rev Rheumatol. 2011 May 31;7(7):399–408
Disclosure of Interest None declared