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04-02-2020 | Rheumatology | News | Article

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Multidisciplinary approach needed for rheumatology patients with coronary artery disease

medwireNews: An analysis of percutaneous coronary intervention (PCI) outcomes among people with rheumatic diseases suggests that those with systemic sclerosis (SSc) have an elevated risk for multiple in-hospital complications, while patients with systemic lupus erythematosus (SLE) have an increased bleeding risk.

The researchers evaluated data from 6,558,947 patients who underwent PCI in the USA between 2004 and 2014, of whom 1.06% had rheumatoid arthritis (RA), 0.27% had SLE, and 0.05% had SSc. The number of RA patients undergoing PCI increased significantly from 0.8% in 2004 to 1.4% in 2014, while rates remained approximately stable in those with SLE or SSc.

After adjustment for factors including age, sex, smoking, and dyslipidemia, individuals with SSc had a significantly higher risk for any in-hospital adverse outcome than those without autoimmune rheumatic disease (AIRD), at rates of 13.6% and 9.0%, respectively, and an odds ratio of 1.13.

Similarly, the risk for the individual outcomes of all-cause mortality (OR=1.32), bleeding (OR=1.50), and stroke (OR=1.36) was significantly higher among people with SSc relative to those with no AIRD, the team reports in Rheumatology.

Patients with RA and those with SLE had numerically higher rates of in-hospital adverse outcomes than those in the control group (11.6 and 12.3 vs 9.0%, respectively), but these differences did not reach statistical significance on multivariable analysis.

Rates of individual outcomes were also comparable in these groups, with the exception of a significantly increased risk for bleeding in SLE patients versus those without AIRD (OR=1.19) and, conversely, a significantly reduced risk for all-cause mortality among those with RA (OR=0.79).

These findings “could be explained by differences in pharmacological regimens that remain unadjusted for in our analysis or other residual confounders,” or a “further possibility to explain the apparent reduced mortality in RA subjects is that further ischaemic events may occur in the long-term phase, which is beyond the follow-up duration in our study,” say the study authors.

They also investigated whether steroid use impacted complication risk, finding that RA patients on steroid therapy had a lower risk for all-cause mortality, stroke, and vascular complications after PCI than controls without AIRDs but at the cost of an increased risk for bleeding and cardiac complications.

Mamas Mamas (Keele University, Stoke-on-Trent, UK) and co-researchers say that these results “emphasize the importance of bleeding and ischaemic risk assessment in such patients prior to intervention, and [support] the implementation of bleeding avoidance strategies to minimize the risk of bleeding in patients with chronic steroid use.”

And they conclude that management of patients with AIRDs, who have “an inherently high risk” of progressive coronary artery disease, “should involve a multiteam approach with rheumatologists.”

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

Rheumatology 2020; doi:10.1093/rheumatology/kez639

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