Long-term follow-up after percutaneous coronary intervention in patients with systemic lupus erythematosus

Cardiovascular Outcomes in Systemic Lupus Erythematosus

PURPOSE OF THE REVIEW

To review cardiovascular outcomes (CVE) in systemic lupus erythematosus (SLE) that evolves over time.

RECENT FINDINGS

Inception cohorts now report long-term data, and large population registries add to our knowledge. Mortality and cardiovascular morbidity remain high with a risk ratio of 2-3. SLE disease activity-related inflammation accounts for higher CVE incidence ratio in the first year following diagnosis with accelerated atherosclerosis contributing to CVE in about a quarter to a third of the patients later in the disease course. Immunomodulation and disease control are associated with improved cardiovascular outcomes. Validation of modified risk stratification tools and studies evaluating primary prevention with aspirin and hydroxychloroquine are reported. Increased awareness of high mortality associated with cardiac inflammation, improved outcomes with early disease control, aggressive management of risk factors, hypertension, obesity, and high cholesterol with modifying risk stratification will result in more favorable outcomes in SLE patients.

Clinical characteristics and in-hospital outcome of patients with acute coronary syndromes and systemic lupus erythematosus

OBJECTIVE

Due to the chronic inflammation associated with systemic lupus erythematosus (SLE), patients develop premature atherosclerosis and the disease is a risk factor for acute myocardial infarction. The best interventional treatment for acute coronary syndrome (ACS) in these patients is unclear. The objective of this study is to describe the baseline characteristics, clinical manifestations, treatment and in-hospital outcome of patients with SLE and ACS.

METHODS

Eleven SLE patients with ACS were analyzed retrospectively between 2004 and 2011. The following data were obtained: age, gender, clinical and electrocardiographic characteristics, Killip class, risk factors for ACS, myocardial necrosis markers (CK-MB and troponin), creatinine clearance, left ventricular ejection fraction, inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), drugs used during hospital stay, treatment (medical, percutaneous or surgical) and in-hospital outcome. The statistical analysis is presented in percentages and absolute values.

RESULTS

Ten of the patients (91%) were women. The median age was 47 years. Typical precordial pain was present in 91%. Around 73% had positive erythrocyte sedimentation rate. The vessel most often affected was the anterior descending artery, in 73%. One patient underwent coronary artery bypass grafting, seven underwent percutaneous coronary intervention with bare-metal stents and three were treated medically. In-hospital mortality was 18%.

CONCLUSIONS

Despite the small number of patients, our findings were similar to those in the literature, showing coronary artery disease in young people with SLE due to premature atherosclerosis and a high mortality rate.

Recurrent very late stent thrombosis in a systemic lupus erythematous patient

Coronary artery disease is the most important cause of mortality in patients with systemic lupus erythematous (SLE). After stenting for coronary artery disease in SLE patients similar to non-SLE patients, the risk of stent thrombosis is always present. Although there are reports of stent thrombosis in SLE patients, very late recurrent stent thrombosis is rare. We experienced a case of very late recurrent stent thrombosis (4 times) in a patient with SLE.