Outcomes of hospitalizations for myocardial infarctions and cerebrovascular accidents in patients with systemic lupus erythematosus

Abstract

Objective. Patients with systemic lupus erythematosus (SLE) have increased risks of acute myocardial infarction (AMI) and cerebrovascular accident (CVA), but it is not known whether they have worse outcomes after AMI or CVA compared with patients without SLE. This study compared in-hospital mortality, length of stay, and other measures of severity (congestive heart failure or need for coronary artery bypass grafting after AMI; discharge to a skilled nursing facility after CVA) between patients with SLE and patients without SLE who were hospitalized for AMI or CVA.Methods. Data on all patients hospitalized in California with either AMI or CVA from 1996 to 2000 were abstracted from a state hospitalization database. Outcomes after AMI were compared between 519 patients with SLE and 214,771 patients without SLE, and outcomes after CVA were compared between 905 patients with SLE and 293,326 patients without SLE. Analyses were performed separately for men and women.Results. Among women with AMI, there were no differences in the risk of in-hospital mortality, long length of stay, or congestive heart failure between patients with SLE and those without SLE, but women with SLE were less likely to undergo coronary artery bypass grafting. Outcomes after AMI did not differ between men with SLE and men without SLE. Among women with CVA, there were no differences in outcomes between patients with SLE and patients without SLE. Men with SLE were almost twice as likely to have a long length of stay after CVA than were men without SLE.Conclusion. Outcomes after AMI and CVA are generally similar between patients with SLE and those without SLE.Patients with systemic lupus erythematosus (SLE) have an increased risk of cardiovascular and cerebrovascular events compared with persons without SLE. Risks for acute myocardial infarctions (AMI) have been estimated to be 2-52 times higher in patients with SLE, and risks for cerebrovascular accident (CVA) have been estimated to be 2-10 times higher in these individuals (1-4). Atherosclerotic events also tend to occur at younger ages in patients with SLE, and the relative risks for these events are higher among younger patients (2,3). However, it is not known whether AMI or CVA is more severe in patients with SLE. Most studies that have noted the severity of atherosclerotic events in patients with SLE have been small case series (5-11). In the only large study, mortality after AMI and CVA was similar among patients with end-stage lupus nephritis and patients with other causes of end-stage renal disease (12). Measures of severity other than mortality were not examined, and the study did not include patients without end-stage renal disease or men. Because patients with end-stage renal disease represent only a small and highly selected subset of patients with SLE, these findings may not apply to patients with SLE who do not have renal failure.In this study, the severity of AMI and the severity of CVA were compared between patients with SLE and those without SLE, in a large population-based sample...

Cardiovascular Outcomes in Systemic Lupus Erythematosus: Big Studies for Big Questions

“…The findings by Shah and colleagues are in contrast to those reported by Ward in a smaller but geographically similar population over a comparable period of time 15 . He demonstrated higher absolute in-hospital mortality rates for both SLE patients and controls than Shah and colleagues, but concluded there was not a significantly higher rate of adverse outcomes in SLE compared to those without SLE or those with diabetes.…”

“…In this situation length of hospital stay is therefore likely to reflect a more severe clinical course or complications. The mean (SD) age for both SLE patients [61 (15) yrs] and the comparison group [73 (13) yrs] was also higher in that study 15 . Importantly, they were able to examine coronary intervention rates and outcomes and demonstrated a decreased likelihood of coronary artery bypass graft (CABG) in SLE patients compared to those without SLE, with similar low mortality rates over a short followup period between the 2 groups following CABG.…”

“…Importantly, they were able to examine coronary intervention rates and outcomes and demonstrated a decreased likelihood of coronary artery bypass graft (CABG) in SLE patients compared to those without SLE, with similar low mortality rates over a short followup period between the 2 groups following CABG. Although a few small case series have described an acceptable immediate outcome in patients with SLE undergoing coronary intervention, the long or medium-term outcome in these patients remains unknown [15][16][17] .…”

“…Neither of these studies 12,15 indicated other important outcome measures, such as size or type of infarct, post-MI left ventricular function, subsequent disability, or intermediate-term mortality rates. A further key question is which contributing factors affect outcome of CHD in SLE.…”

Atherogenesis and Vascular Disease in SLE

“…African-origin, in particular, is associated in an independent fashion with a worsened probability of survival. The outcomes of hospitalization for acute myocardial infarction were thought to be identical between patients with and without SLE, despite women with SLE being less likely to undergo coronary artery bypass grafting (Ward, 2004). Whether this is due to a decreased need for the procedure or whether reflects a decreased referral or reduced access to the surgery, is not established.…”