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Poor outcomes after acute myocardial infarction in systemic lupus erythematosus

Mansi A Shah¹, Amber M Shah, Eswar Krishnan

¹Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA.

The Journal of Rheumatology

|February 12, 2009

Insights

Systemic lupus erythematosus (SLE) patients face higher risks for poor outcomes after acute myocardial infarction (MI), similar to diabetes mellitus (DM). These findings highlight the need for aggressive care in SLE patients post-MI.

Area of Science:

Cardiology
Rheumatology
Public Health

Background:

Systemic lupus erythematosus (SLE) is linked to an increased risk of acute myocardial infarction (MI).
However, the outcomes following MI in SLE patients remain understudied.
This study compares post-MI outcomes in SLE patients against those with diabetes mellitus (DM) and a control group.

Purpose of the Study:

To compare post-acute myocardial infarction (MI) outcomes in patients with Systemic Lupus Erythematosus (SLE).
To evaluate outcomes in SLE patients against those with diabetes mellitus (DM) and individuals without these conditions.
To identify risks for prolonged hospitalization and in-hospital mortality after acute MI.

Main Methods:

Analysis of the US Nationwide Inpatient Sample (1993-2002).
Logistic regression used to determine odds ratios (OR) for prolonged hospitalization.
Cox proportional hazards regression used to calculate hazard ratios (HR) for in-hospital mortality, adjusting for multiple covariates.

Main Results:

In-hospital mortality rates were 8.3% for SLE, 6.2% for DM, and 4.7% for controls.
SLE patients had a higher odds ratio for prolonged hospitalization (OR 1.48) compared to DM patients (OR 1.30).
SLE patients also showed a higher hazard ratio for in-hospital mortality (HR 1.65) than DM patients (HR 1.11).

Conclusions:

Systemic lupus erythematosus (SLE) significantly increases the risk of adverse outcomes after acute myocardial infarction (MI).
The risk of poor outcomes in SLE patients post-MI is comparable to that observed in patients with diabetes mellitus (DM).
Appropriate triage and aggressive management are crucial for improving outcomes in SLE patients experiencing acute MI.

Read full analysis

Abstract

Objective:

Systemic lupus erythematosus (SLE) is associated with higher risk for acute myocardial infarction (MI); but the post-infarction outcomes among these patients are unknown. Our objective was to compare post-acute MI outcomes in patients with SLE to those with diabetes mellitus (DM) and those with neither condition.

Methods:

We analyzed the risk for prolonged hospitalization and in-hospital mortality following acute MI in the 1993-2002 US Nationwide Inpatient Sample. We used logistic regression to calculate odds ratios (OR) for prolonged hospitalization and Cox proportional hazards regression to calculate hazard ratios (HR) for in-hospital mortality with and without adjustments for age, sex, race/ethnicity, socioeconomic status, and presence of congestive heart failure.

Results:

For the SLE (n = 2192), DM (n = 236,016), SLE/DM (n = 474), and control (n = 667,956) groups, the in-hospital mortality rates were 8.3%, 6.2%, 5.7%, and 4.7%, respectively. In multivariable regression models, all 3 disease groups had higher adverse outcome risk compared to control. The OR for prolonged hospitalization was higher for those with SLE (OR 1.48, 95% CI 1.32-1.79) compared to those with DM (OR 1.30, 95% CI 1.28-1.32). A similar pattern was observed for hazard ratios for in-hospital mortality as well (SLE, HR 1.65, 95% CI 1.33-2.04; DM, HR 1.11, 95% CI 1.07-1.14).

Conclusion:

SLE, like DM, increases risk of poor outcomes after acute MI. These patients need to be triaged appropriately for aggressive care.

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