Recurrent myocardial infarction due to coronary artery aneurysm in Behçet's syndrome: a case report

Uveitis as a potential predictor of acute myocardial infarction in patients with Behcet's disease: a population-based cohort study

OBJECTIVES

To investigate whether uveitis is a predictor of acute myocardial infarction (AMI) among patients with Behcet's disease (BD).

DESIGN

Retrospective cohort study.

SETTING

Patients with BD were retrieved from the whole population of the Taiwan National Health Insurance Research Database from 1 January 2001 to 31 December 2013.

PARTICIPANTS

Among the 6508 patients with BD, 2517 (38.7%) were in the uveitis group and 3991 were in the non-uveitis group.

PRIMARY AND SECONDARY OUTCOME MEASURES

Kaplan-Meier curves were generated to compare the cumulative hazard of AMI in the uveitis and non-uveitis groups. Multivariate Cox regression analysis was used to estimate the adjusted HRs and 95% CI of AMI, and was adjusted for age, gender, systemic comorbidities (eg, hypertension, diabetes, hyperlipidaemia, smoking) and clinical manifestation of BD (eg, oral ulcers, genital ulcers, skin lesions, arthritis and gastrointestinal involvement).

RESULTS

The mean age of the BD cohort was 38.1±15.1 years. Compared with non-uveitis patients, uveitis patients were significantly younger and male predominant. There was no significant difference between the two groups for most proportions of systemic comorbidities and clinical manifestations. The Kaplan-Meier method with the log-rank test showed that the uveitis group had a significantly higher cumulative hazard for patients with AMI compared with the non-uveitis group (p<0.0001). In the multivariable Cox regression after adjustment for confounding factors, patients with uveitis had a significantly higher risk of AMI (adjusted HR 1.87; 95% CI 1.52 to 2.29). Other significant risk factors for AMI were age, hypertension, smoking, and skin lesions.

CONCLUSIONS

Statistical analyses from the nationwide database demonstrated that uveitis is a potential predictor of AMI in patients with BD.

Acute Myocardial Infarction as the Initial Presentation of Behcet's Syndrome

Behcet's disease (BD) is clinically characterized by recurrent oral and genital ulcers and ocular symptoms. However, systemic manifestations involving the lungs, gastrointestinal tract, kidneys, and heart are well known. Acute myocardial infarction (MI) is a rare manifestation of Behcet's syndrome and usually results from coronary arteries vasculitis, leading to aneurysms. More uncommon is the occurrence of acute MI as the initial presenting symptom. Hereby, we report a case of a young male who presented with acute anterior wall MI sans any other conventional risk factors with a normal angiogram. And 3 years later, he was diagnosed with BD.