Post Chikungunya Chronic Arthritis: Systemic Inflammatory Status Triggering Acute Coronary Syndrome
Dhruvkumar M Patel1, Mukundkumar V Patel2, Kamal H Sharma3
1Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India.
Insights
Post Chikungunya Chronic Arthritis (PCCA) is common in Acute Coronary Syndrome (ACS) patients. This post-infective inflammation may destabilize coronary plaques, increasing ACS risk.
Area of Science:
- Cardiology
- Rheumatology
- Infectious Diseases
Background:
- Atherosclerosis, inflammation, and coronary plaque destabilization are interconnected.
- Infections can trigger Acute Coronary Syndrome (ACS) via systemic inflammation.
Purpose of the Study:
- To evaluate the prevalence of Post Chikungunya Chronic Arthritis (PCCA) in ACS patients.
- To compare PCCA prevalence between ACS patients and a control group undergoing elective surgery.
Main Methods:
- A prospective case-control observational study involving 400 ACS patients and 400 controls.
- Exclusion criteria included unmet ACS criteria, recent myocardial infarction in controls, and prolonged PCCA or positive IgM anti-CCP.
Main Results:
- PCCA was present in 6% of ACS cases versus 2% of controls (OR 3.0, 95% CI 1.4-6.4).
- ACS patients with PCCA were younger, more often women, and had higher rates of diabetes, hypertension, chronic kidney injury, and CRP.
- Adjusted analysis confirmed PCCA was three times more common in ACS patients (OR 3.0, 95% CI 1.3-6.8).
Conclusions:
- Post Chikungunya Chronic Arthritis (PCCA) is a common comorbidity in Acute Coronary Syndrome (ACS) patients.
- Systemic inflammation associated with PCCA may contribute to coronary plaque destabilization and ACS development.
Background:
Atherosclerosis, inflammation and coronary plaque destabilization are linked to each other. Infections due to various microbes may trigger Acute Coronary Syndrome (ACS) by systemic inflammation cascade.
Methods:
We have evaluated the prevalence of Post Chikungunya Chronic Arthritis (PCCA) among 400 consecutive ACS patients (Case group) and compared with control group subjected to elective surgery by the prospective case-control observational study. Cases were excluded if standard criteria of ACS were not satisfied and in the control group if the patient suffered a Myocardial Infarction (MI) within 28 days of elective surgery. PCCA duration more than two years or serum IgM anti-CCP positive patients were also excluded from the case as well as a control group.
Results:
The case and control groups were similar except, less number of heart failure (O.R.7.3, 95% C.I. 3.3-15.9) and chronic kidney injury patients (O.R. 0.5, 95% C.I. 0.3-0.9) in the elective surgery (control) group. PCCA was present in 24 out of 400 ACS cases and 8 out of 400 control group. Among ACS case-patients, those suffering from PCCA tended to be younger and more often women, with more diabetes, hypertension, chronic kidney injury and high mean CRP. In unadjusted analysis PCCA was three times more common in the case versus control (O.R. 3.0, 95% C.I. 1.4- 6.4); results were indistinguishable after multidiscipline adjustment (O.R. 3.0, 95% C.I. 1.3-6.8).
Conclusion:
PCCA is common among patients with ACS and post-infective systemic inflammation of PCCA may trigger plaque destabilization.
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