Impact of Antiphospholipid Syndrome and/or Systemic Lupus Erythematosus on the Long-term Adverse Cardiovascular Outcomes in Patients After Percutaneous Coronary Intervention

Abstract

Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are 2 rare autoimmune disorders which commonly affect women. Several previous studies showed APS to have been evolved from SLE. Secondary APS often coexists with SLE. One common feature relating these 2 diseases are the antiphospholipid antibodies, which are found in most of the patients with APS and in approximately 30% to 40% of patients with SLE, among which, about 10% develop APS. The leading cause of death in these patients is from cardiovascular disease due to accelerated atherosclerosis, which often progresses more rapidly, compared with the general population. However, the impact of APS and/or SLE on the cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) is controversial. Therefore, to solve this issue, we aim to compare the long-term (≥1 year) adverse cardiovascular outcomes after PCI, in patients with APS and/or SLE, and those without these disorders.Medline and EMBASE databases were searched for studies comparing the long-term adverse cardiovascular outcomes between SLE and non-SLE, APS and non-APS, or SLE + APS and non-SLE + non-APS after PCI. We calculated odd ratios (OR) and 95% confidence intervals (CIs) for these categorical variables, and the pooled analyses were performed with RevMan 5.3.Seven studies consisting of a total of 253,436 patients (568 patients in the experimental group and 252,868 patients in the control group) were included in this meta-analysis. During a follow-up period of ≥1 year, mortality and myocardial Infarction (MI) were significantly higher in the experimental group (OR 2.02, 95% CI 1.63–2.49, P < 0.00001 and OR 1.59, 95% CI 1.23–2.05, P = 0.0004, respectively). Major adverse cardiac events and repeated revascularization were also significantly higher in the SLE/APS group (OR 2.40, 95% CI 1.42–4.03, P = 0.001 and OR 2.59, 95% CI 1.26–5.31, P = 0.01, respectively).Antiphospholipid syndrome and SLE are associated with significantly higher long-term (≥1 year) adverse cardiovascular outcomes after PCI. However, because of the limited number of patients and researches done, and due to a larger percentage of heterogeneity observed among several subgroups, this analysis may not generate a powerful result.

16th International congress on antiphospholipid antibodies task force report on clinical manifestations of antiphospholipid syndrome

“…Mortality and myocardial infarction were significantly higher in the experimental group (OR ¼ 2, 95% CI ¼ 1.6-2.5, P < 0.01 and OR ¼ 1.6, 95% CI ¼ 1.2-2.1, P < 0.0004, respectively); major adverse cardiac event and repeated revascularization were also significantly higher in the SLE/APS group (OR ¼ 2.4, 95% CI ¼ 1.4-4, P < 0.001 and OR ¼ 2.6, 95% CI ¼ 1.3-5.3, P < 0.01, respectively). 13 Further, Nazir and Colleagues investigated acute myocardial infarction (AMI) in 40 APS patients identified from 27 case reports and case series. Mean age at presentation was lower than in the general population (41.1 AE 13.6) and 45% were female, ST-elevation was the most common presentation.…”

An unusual case of heart attack

“…In a meta-analysis, the long-term cardiovascular adverse outcomes after PCI were compared between patients with APS and/or SLE and those without. Mortality, myocardial infarction, major cardiac events, and repeated revascularization were significantly higher in the APS and/or SLE group [3].…”

Acute coronary syndrome leading to revision of a co-morbid condition in a young man with arthritis

“…The relative roles of coronary thrombosis and of coronary atherosclerosis in patients with APLS and/or SLE have not yet been thoroughly studied [21]. On the other hand, the issue of percutaneous coronary interventions (PCI) and CABG in patients with SLE and ACS needs further assessment because of equivocal data with regard to their appropriateness and effectiveness and increased associated risks [22].…”