Long-Term Outcome of Patients with Antiphospholipid Syndrome Who Undergo Percutaneous Coronary Intervention

Abstract

Objectives: Patients with antiphospholipid antibody syndrome (APS) have an increased risk of atherothrombotic complications. There are limited data regarding the outcome of patients with APS who undergo percutaneous coronary intervention (PCI). Accordingly, we aimed to assess the long-term outcomes of these patients. Methods: Nineteen APS patients who underwent PCI between the years 2003 and 2008 were compared to 380 patients who had undergone PCI during the same period (PCI group) and were matched by age (±5 years), gender, diabetes and hypertension. In addition, APS patients were compared to 1,458 patients with ST segment elevation myocardial infarction (MI) who were treated with PCI during the same period. Six-month to 4-year clinical outcomes were evaluated. Results: The indication for PCI in the APS group was acute coronary syndrome in 52.6% of patients. After 1 year of follow-up, patients with APS had higher rates of target vessel revascularization than the other two groups, which translated to higher rates of major adverse cardiac events. There were no differences in MI or mortality rates between the groups. Conclusions: Patients with APS who undergo PCI have worse long-term clinical outcomes, driven by higher rates of revascularization, than other patients undergoing PCI. Further study is warranted to examine the mechanisms underlying these findings.

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

“…The study by Perl et al in 2011 also showed a remarkably higher rate of repeated revascularization (target vessel revascularization) in patients with APS who underwent coronary angioplasty despite a similar use of drug eluting stents and diabetic status in both the experimental and the control group. 11 The study by Smythe et al in 1976 showed an increased incidence of MI among patients with SLE, which resulted in an increased mortality rate among such patients. The study by Hak et al 21 also concluded that they found a statistically increased risk of cardiovascular diseases among patients with SLE.…”

Antiphospholipid syndrome and the heart: A case series and literature review

“…Available data on the short and long-term outcome of PCI in APS patients come from reports, some of which come date before the new era of stents and contemporary PCI techniques [63][64][65][66]. More recently, a retrospective study assessed the long-term outcome of patients with APS who underwent PCI [67]. The investigators report worse long-term clinical outcomes mostly driven by higher rates of thrombotic recurrences without an increase in mortality with respect to controls [67].…”

“…More recently, a retrospective study assessed the long-term outcome of patients with APS who underwent PCI [67]. The investigators report worse long-term clinical outcomes mostly driven by higher rates of thrombotic recurrences without an increase in mortality with respect to controls [67].…”

“…This to balance the risk of bleeding with that of thrombosis, i.e. the duration of dual antiplatelet therapy in addition to anticoagulation, which might lead to increased bleeding risk [68] , and the choice of bare metal versus drug-eluting stents [67].…”

A male patient with myocardial infarction as a first manifestation of antiphospholipid syndrome — treatment with rivaroxaban

“…[9] przeprowadzone w grupie 1000 pacjentów z APS, w której drugą z kolei przyczyną zgonu po infekcjach bakteryjnych (21%) był zawał serca (19%). Stwierdzono, że pacjenci z aPL poddani przezskórnej interwencji wieńcowej częściej wymagają rewaskularyzacji i występuje u nich więcej ponownych epizodów sercowo-naczyniowych w obserwacji odległej niż u osób bez tych przeciwciał [10]. Zawał serca jest kontrowersyjnym wskazaniem do diagnostyki trombofilii, którą jednak należy rozważyć u chorych poniżej 50.…”