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Autoimmune Diseases May Increase Adverse Cardiovascular Events After Percutaneous Coronary Intervention: A Systematic
Guodong Ma1, Huiqiang Zhao1, Yutong Fei2
1Department of Heart Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Insights
Patients with autoimmune diseases undergoing percutaneous coronary intervention (PCI) face higher risks of major adverse cardiovascular events (MACE), repeat revascularization, and myocardial infarction (MI) within one year. Long-term follow-up also indicates an increased risk of death in these patients.
Area of Science:
- Cardiology
- Immunology
- Clinical Outcomes Research
Background:
- Outcomes for patients with autoimmune diseases following percutaneous coronary intervention (PCI) are not well-established.
- Comparing post-PCI outcomes in autoimmune disease patients versus those without is crucial for risk stratification.
Purpose of the Study:
- To systematically review and synthesize evidence on the comparative outcomes of patients with and without autoimmune diseases after PCI.
- To identify specific adverse events and mortality risks associated with autoimmune conditions post-PCI.
Main Methods:
- A comprehensive literature search was conducted across Medline, EMBASE, and the Cochrane Library up to April 2017.
- Included studies compared outcomes such as mortality, major adverse cardiovascular events (MACE), repeat revascularization, myocardial infarction (MI), and restenosis.
- Risk of bias was assessed using NOS and AHRQ criteria, with evidence certainty rated by GRADE.
Main Results:
- Analysis of 11 studies revealed that patients with autoimmune diseases had significantly higher risks of MACE, repeat revascularization, ischemia/MI, and restenosis within one year post-PCI.
- Long-term follow-up (11 years) showed increased risks of MACE and all-cause mortality in patients with autoimmune diseases.
- Specific risk ratios and confidence intervals were reported for each outcome, indicating statistically significant increases in adverse events.
Conclusions:
- Very low-quality evidence suggests patients with autoimmune diseases are more prone to MACE, repeat revascularization, MI, and restenosis within one year after PCI.
- A higher risk of death is observed in autoimmune disease patients during an 11-year follow-up post-PCI.
- Close monitoring for restenosis, recurrent ischemia/MI, and other adverse events is essential for autoimmune disease patients undergoing PCI.
Background:
Outcomes of patients with autoimmune diseases after percutaneous coronary intervention (PCI), as compared to those without autoimmune disease, remain unclear.
Methods:
We searched Medline, EMBASE, and the Cochrane Library from their inception to 1 April 2017. All studies comparing the following outcomes of patients with and without autoimmune diseases after PCI were included: long-term mortality, major adverse cardiovascular events (MACE), repeat revascularisation, myocardial ischaemia or myocardial infarction (MI), restenosis, and in-hospital mortality. The Newcastle-Ottawa Quality Assessment Scale (NOS) and the quality assessment form of the Agency for Healthcare Research and Quality (USA) (AHRQ) were used for assessing the risk of bias, and the certainty of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
Results:
A total of 11 studies were included in our analysis. Compared with patients without autoimmune diseases, those with autoimmune diseases carried an increased risk of MACEs (relative risk (RR): 2.24, 95% confidence interval (CI): 1.20-4.16; heterogeneity: p=0.128, I2=56.9%), repeat revascularisation (RR: 1.66, 95% CI 95%: 1.01-2.72; heterogeneity: p=0.057, I2=65.1%), ischaemia or MI (RR: 2.80, 95% CI: 1.38-5.65; heterogeneity: p=0.871, I2=0.0%), and restenosis (RR: 2.06, 95% CI: 1.39-3.07; heterogeneity: p=0.665, I2=0.0%) during the one-year follow-up after PCI, and carried an increased risk of MACEs (RR: 1.10, 95% CI: 1.04-1.17) and death (RR: 1.38, 95% CI: 1.25-1.51) during the 11-year follow-up after PCI.
Conclusions:
Evidence of very low quality showed that during the one-year follow-up period, patients with autoimmune diseases after PCI were more likely to experience MACEs, repeat revascularisation, myocardial ischaemia or MI, and restenosis. During the 11-year follow-up period, patients with autoimmune diseases after PCI were more likely to die. It is therefore important to watch for restenosis, repeat ischaemia or MI and other adverse events more carefully in patients with autoimmune diseases after PCI.
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