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Short- and Long-term Outcomes in Patients with Connective Tissue Diseases Undergoing Percutaneous Coronary
Li Zhou, Hui Chen, Wei-Ping Li
1Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Insights
Coronary artery disease (CAD) in connective tissue diseases (CTDs) presents severe lesions and higher risks post-percutaneous coronary intervention (PCI). Patients with CTD undergoing PCI face increased stent thrombosis and target vessel revascularization rates.
Area of Science:
- Cardiology
- Rheumatology
- Interventional Cardiology
Background:
- Connective tissue diseases (CTDs) are associated with increased morbidity and mortality from coronary artery disease (CAD).
- Risk factors and clinical profiles of CAD in CTD patients differ from the general population.
- Understanding outcomes in CTD patients undergoing percutaneous coronary intervention (PCI) is crucial.
Purpose of the Study:
- To evaluate short- and long-term clinical outcomes.
- To analyze outcomes in patients with CTD undergoing PCI with stent implantation.
Main Methods:
- Retrospective analysis of 106 consecutive CTD patients undergoing PCI (Jan 2009-June 2012).
- Data collected included clinical characteristics, coronary angiogram findings, and major adverse cardiac events (MACEs).
- Median follow-up duration was 3 years.
Main Results:
- 86.8% of patients had traditional CAD risk factors; 73.6% had multivessel disease.
- Long-term follow-up (36 months) showed a 12.3% cardiac death rate, 9.4% stent thrombosis, and 14.2% target vessel revascularization (TVR).
- Hypertension, anterior myocardial infarction, prolonged steroid use, and elevated C-reactive protein were independent predictors of MACEs.
Conclusions:
- CTD patients with CAD often present with severe coronary lesions.
- PCI in CTD patients is associated with higher rates of stent thrombosis and TVR.
- Both traditional and non-traditional risk factors influence outcomes in this population.
Background:
Coronary artery disease (CAD) is a leading cause of morbidity and mortality in patients with connective tissue diseases (CTDs). Risk factors and clinical characteristics in these patients are not equivalent to those in traditional CAD patients. The objective of this study was to report short- and long-term clinical outcomes in a consecutive series of patients with CTD who underwent percutaneous coronary intervention (PCI) with stent implantation.
Methods:
The study group comprised 106 consecutive patients with CTD who underwent PCI in Beijing Friendship Hospital between January 2009 and June 2012. Medical records were analyzed retrospectively including clinical basic material, coronary angiogram data, and the incidence of major adverse cardiac events (MACEs) during the short- and long-term (median 3 years) follow-up.
Results:
Ninety-two of the patients (86.8%) had one or more traditional CAD risk factors. Multivessel disease was present in more than 2/3 of patients (73.6%). The left anterior descending coronary artery was the most commonly affected vessel (65.1%). Five bare-metal stents and 202 drug-eluting stents were implanted. After a median follow-up period of 36 months, thirteen patients (12.3%) died from cardiac causes, the rate of stent thrombosis was 9.4%, and the rate of target vessel revascularization (TVR) was 14.2%. Multivariate analysis revealed that hypertension (hazard ratio [HR] = 3.07, 95% confidence interval [CI]: 1.30-7.24, P = 0.041), anterior myocardial infarction (HR = 2.77, 95% CI: 1.06-7.03, P = 0.04), longer duration of steroid treatment (HR = 3.60, 95% CI: 1.43-9.08, P = 0.032), and C-reactive protein level >10 mg/L (HR = 3.98, 95% CI: 1.19-12.56, P = 0.036) were independent predictors of MACEs.
Conclusions:
Patients with CTD and CAD may have severe coronary lesions. PCI in these patients tends to result in an increased rate of stent thrombosis and TVR during long-term follow-up, which may be influenced by traditional and nontraditional risk factors.
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