Does SLE Increase the Risk for Perioperative Major Adverse Cardiovascular Events?

CAT scan of the heart
CAT scan of the heart
Future research should look to improve perioperative management in people with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) puts patients at higher risk for experiencing major adverse cardiovascular events (MACE) following non-cardiac surgery, particularly in younger patients, according to researchers. Study results were published in the Journal of Thrombosis and Thrombolysis.

SLE significantly increases the risk for cardiovascular (CV) disease. Women with SLE were approximately 5 times more likely to experience MACE than their non-SLE counterparts. Investigators were interested in further exploration, due to limited available data, the uncertainty regarding whether SLE also elevates perioperative risks of MACE  — defined in the study as myocardial infarction (MI), stroke, and death — in general surgeries.

Researchers used data from the Healthcare Cost and Utilization Project National Inpatient Sample database. From a total of 17,853,194 hospitalizations meeting inclusion criteria, they identified SLE in 70,578 (0.4%) cases. Patients with SLE tended to be younger (52.1±15.8 vs 53.7±19.6 years, P <.001), women (90.3% vs 64.7%, P <.001), and black (20.1% vs 9.6%, P <.001) compared with patients without SLE.

Results indicated elevated frequency of perioperative MACE in people with SLE (2.4% vs 2%, P <.001; adjusted odds ratio (aOR) 1.25, 95% CI 1.18-1.31). When stratified by gender, SLE was still positively associated with MACE in both men (aOR 1.17; 95% CI, 1.03-1.33) and women (aOR 1.29; 95% CI, 1.22-2.37) separately.

Patients with SLE <50 years of age had a higher likelihood of MI (aOR 1.32; 95% CI, 1.05-1.66) and death (aOR 1.58; 95% CI, 1.40-1.77). However, there was no difference in the risk for ischemic stroke in patients either with or without SLE.

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Study limitations included possible coding errors and reporting bias; uncertainty regarding whether patients met American College of Rheumatology (ACR) and other classification criteria; lack of information on antithrombotic and immunosuppressive medication regimens, as well as antiphospholipid antibody levels; lack of information on use of statins, anticoagulants, and antiplatelet medications; no indications on causes of death; and lack of information regarding the sequence of cardiovascular complications following surgery.

The researchers noted that further study is required in this patient population, in order to improve patient management and outcomes in patients with SLE who undergo non-cardiac surgeries.

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Smilowitz NR, Katz G, Buyon JP, Clancy RM, Berger JS. Systemic lupus erythematosus and the risk of perioperative major adverse cardiovascular events. J Thromb Thrombolysis. 2017;45(1):13-17. doi:10.1007/s11239-017-1591-0