Systemic Lupus Erythematosus Increases MACE Risk After Noncardiac Surgery

Group of doctors, in a surgical room of a clinic, performing a surgical intervention, with their proper attire to operate, in a sterile field, operating a young person, very focused on their work
In research presented at the ACR Convergence 2021, investigators estimated the risk of major adverse cardiac events in patients with systemic lupus erythematosus undergoing moderate-risk to high-risk surgery.

The following article is a part of conference coverage from the American College of Rheumatology (ACR) Convergence 2021, being held virtually from November 3 to 10, 2021. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the ACR Convergence 2021.


Patients with systemic lupus erythematosus (SLE) were found to be at increased risk for experiencing a major adverse cardiac event (MACE) within 1 month after noncardiac surgery, according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held November 3-10, 2021. However, the researchers suggest that the risk may be due to underlying comorbidities as the association between SLE and MACE became nonsignificant after adjusting for preoperative Revised Cardiac Risk Index (RCRI) scores.

The association between SLE and cardiovascular disease has been well studied, and cardiovascular disease is a known risk factor for postsurgical MACE. The researchers designed the current retrospective observational study to estimate MACE risk in patients with SLE undergoing moderate-risk to high-risk noncardiac surgery compared with control patients with diabetes and control patients without diabetes. Deidentified administrative data on patients who underwent noncardiac surgery between 2007 and 2020 were obtained from the Optum Clinformatics Data Mart. Patients who underwent low-risk procedures such as ocular surgeries or simple skin procedures were excluded.

From the remaining data pool of surgical patients, the researchers defined an SLE cohort, a cohort with diabetes, and a cohort without diabetes. Patients with SLE were matched by age and gender to patients in the cohorts with and without diabetes. The primary outcome was MACE (defined as death, ischemic stroke, myocardial infarction, or pulmonary embolism according to International Classification of Diseases [ICD] or Current Procedural Terminology® [CPT®] codes) within 1 month following surgery. Multivariable conditional logistic regression was used to estimate the odds of the primary outcome among the 3 cohorts after adjusting for RCRI score and race. Multivariable logistic regression models performed for MACE in patients with SLE included RCRI score, age, race, sex, and SLE disease activity as determined by the Garris index.

Overall, 4750 patients with SLE, 484,986 control patients without diabetes, and 496,381 control patients with diabetes were included in the analysis. No significant differences in MACE rates were observed between patients with SLE and those with diabetes after matching. Before adjustment, patients with SLE were found to be at increased risk for MACE compared with patients without diabetes (odds ratio [OR] 1.51; 95% CI, 1.09-2.08); however, this association became nonsignificant after adjustments were made for RCRI scores (OR 0.97; 95% CI, 0.70-1.36). Among patients with SLE, older age, higher RCRI scores, and non-White race were associated with increased MACE risk; no association was reported with sex, preoperative cardiac testing, and SLE disease activity.

The study investigators conclude, “Patients with SLE have an increased risk [for] MACE within one month after surgery similar to diabetes controls but higher than non-diabetes controls. This risk normalizes after adjusting for pre-operative RCRI scores, suggesting that SLE patients are at an increased risk of MACE because of underlying comorbidities, including cardiovascular disease. Our results indicate that SLE confers an increased risk for MACE, independently of disease severity, mediated by pre-existing cardiovascular disease.”

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


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Bruera S, Lei X, Blau B, et al. Increased risk of major adverse cardiac events in patients with systemic lupus erythematosus after non-cardiac surgery. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 128.