Sara C Martinez1, Mohamed Mohamed2,3, Jessica Potts2, Abhishek Abhishek4, Edward Roddy5,6, Michael Savage7, Aditya Bharadwaj8, Chun Shing Kwok2,3, Rodrigo Bagur2, Mamas A Mamas2. 1. Division of Cardiology, Providence St. Peter Hospital, Olympia, WA, USA. 2. Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK. 3. Royal Stoke University Hospital, Stoke-on-Trent, UK. 4. Academic Rheumatology, University of Nottingham, Nottingham, UK. 5. School of Primary, Community and Social Care, Keele University, UK. 6. Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Haywood Hospital, Burslem, UK. 7. Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA, USA. 8. Cardiology, Loma Linda University, Loma Linda, CA, USA.
Abstract
OBJECTIVE: Patients with autoimmune rheumatic disease (AIRD) are at an increased risk of coronary artery disease. The present study sought to examine the prevalence and outcomes of AIRD patients undergoing percutaneous coronary intervention (PCI) from a national perspective. METHODS: All PCI-related hospitalizations recorded in the US National Inpatient Sample (2004-2014) were included, stratified into four groups: no AIRD, RA, SLE and SSc. We examined the prevalence of AIRD subtypes and assessed their association with in-hospital adverse events using multivariable logistic regression [odds ratios (OR) (95% CI)]. RESULTS: Patients with AIRD represented 1.4% (n = 90 469) of PCI hospitalizations. The prevalence of RA increased from 0.8% in 2004 to 1.4% in 2014, but other AIRD subtypes remained stable. In multivariable analysis, the adjusted odds ratio (aOR) of in-hospital complications [aOR any complication 1.13 (95% CI 1.01, 1.26), all-cause mortality 1.32 (1.03, 1.71), bleeding 1.50 (1.30, 1.74), stroke 1.36 (1.14, 1.62)] were significantly higher in patients with SSc compared with those without AIRD. There was no difference in complications between the SLE and RA groups and those without AIRD, except higher odds of bleeding in SLE patients [aOR 1.19 (95% CI 1.09, 1.29)] and reduced odds of all-cause mortality in RA patients [aOR 0.79 (95% CI 0.70, 0.88)]. CONCLUSION: In a nationwide cohort of US hospitalizations, we demonstrate increased rates of all adverse clinical outcomes following PCI in people with SSc and increased bleeding in SLE. Management of such patients should involve a multiteam approach with rheumatologists.
OBJECTIVE:Patients with autoimmune rheumatic disease (AIRD) are at an increased risk of coronary artery disease. The present study sought to examine the prevalence and outcomes of AIRDpatients undergoing percutaneous coronary intervention (PCI) from a national perspective. METHODS: All PCI-related hospitalizations recorded in the US National Inpatient Sample (2004-2014) were included, stratified into four groups: no AIRD, RA, SLE and SSc. We examined the prevalence of AIRD subtypes and assessed their association with in-hospital adverse events using multivariable logistic regression [odds ratios (OR) (95% CI)]. RESULTS:Patients with AIRD represented 1.4% (n = 90 469) of PCI hospitalizations. The prevalence of RA increased from 0.8% in 2004 to 1.4% in 2014, but other AIRD subtypes remained stable. In multivariable analysis, the adjusted odds ratio (aOR) of in-hospital complications [aOR any complication 1.13 (95% CI 1.01, 1.26), all-cause mortality 1.32 (1.03, 1.71), bleeding 1.50 (1.30, 1.74), stroke 1.36 (1.14, 1.62)] were significantly higher in patients with SSc compared with those without AIRD. There was no difference in complications between the SLE and RA groups and those without AIRD, except higher odds of bleeding in SLEpatients [aOR 1.19 (95% CI 1.09, 1.29)] and reduced odds of all-cause mortality in RApatients [aOR 0.79 (95% CI 0.70, 0.88)]. CONCLUSION: In a nationwide cohort of US hospitalizations, we demonstrate increased rates of all adverse clinical outcomes following PCI in people with SSc and increased bleeding in SLE. Management of such patients should involve a multiteam approach with rheumatologists.