Adverse Outcomes After Percutaneous Coronary Intervention More Prevalent in SSc, SLE

Patients with systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) were found to be at increased odds of adverse clinical outcomes and bleeding, respectively, after percutaneous coronary intervention (PCI), according to study results published in Rheumatology.

Investigators analyzed data from the United States National Inpatient Sample — an all-payer inpatient healthcare database that contains hospital discharge data for 7 to 8 million hospitalizations yearly — for patients who had undergone PCI between 2004 and 2014 (n=6,558,947). Patients were stratified into 4 groups, according to their autoimmune rheumatic disease (AIRD) status: no AIRD, rheumatoid arthritis (RA), SLE, and SSc. The study’s primary outcomes were in-hospital all-cause mortality and in-hospital complications, including bleeding and stroke. Covariates in multivariable logistic regression models included age, sex, ethnicity, income, insurance type, primary diagnosis prior to PCI, and comorbidities.

In this cohort, 90,469 patients (1.4%) had an AIRD diagnosis (n=69,354 with RA; 1.06%; n=17,661 with SLE; 0.27%; and n=3454 with SSc; 0.05%). RA prevalence increased from 0.8% to 1.4% between 2004 and 2014, respectively (P <.001), and rates of SLE and SSc remained stable during that period. Crude rates of all-cause mortality were higher in patients with SLE (1.9%) and SSc (2.4%) compared with patients with RA (1.6%) or no AIRD (1.6%).

Patients with SSc had significantly elevated odds of any complication (odds ratio [OR], 1.13; 95% CI, 1.01-1.26), all-cause mortality (OR, 1.32; 95% CI, 1.03-1.71), bleeding (OR, 1.50; 95% CI, 1.30-1.74), and stroke (OR, 1.36; 95% CI, 1.14-1.62), compared with patients without an AIRD. In patients with SLE, only the risk for bleeding was elevated compared with patients without an AIRD (OR, 1.19; 95% CI, 1.09-1.29). Patients with RA did not have an increased risk for adverse clinical outcomes.  

“Our findings provide operators with further insight into the clinical outcomes of this complex risk group with an inherently high risk [for] progressive [coronary artery disease] and support a multidisciplinary strategy in managing these patients involving rheumatologists,” the investigators concluded.

Reference

Martinez SC, Mohamed M, Potts J, et al. Percutaneous coronary intervention outcomes in patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis [published online January 28, 2020]. Rheumatology (Oxford). doi:10.1093/rheumatology/kez639