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Published on: February 8, 2019
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Myocardial infarction during giant cell arteritis: A cohort study
Hélène Greigert1, Marianne Zeller2, Alain Putot3
1Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Department of Vascular Medicine, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France.
European Journal of Internal Medicine
|February 21, 2021
Summary
Giant cell arteritis (GCA) patients experiencing myocardial infarction (MI) often have type 2 MI (T2MI), linked to inflammation. Unrelated MIs are typically type 1 (T1MI), associated with coronary artery disease and higher prednisone doses.
Area of Science:
- Cardiology
- Rheumatology
- Epidemiology
Background:
- Giant cell arteritis (GCA) is associated with increased cardiovascular risk.
- Characterizing myocardial infarction (MI) in GCA patients is crucial for understanding disease impact.
- Comparing MI characteristics between GCA and non-GCA populations aids in risk stratification.
Purpose of the Study:
- To characterize myocardial infarction (MI) in a cohort of patients with biopsy-proven giant cell arteritis (GCA).
- To compare the features of MI in GCA patients versus a matched non-GCA population.
- To identify specific MI types and potential triggers in GCA patients.
Main Methods:
- Retrospective cohort study of biopsy-proven GCA patients from 2001-2016 in Côte D'Or, France.
- MI cases identified by cross-referencing GCA data with a regional MI registry.
- MI cases (GCA+MI) were matched with controls (non-GCA+MI) for age, sex, and cardiovascular risk factors. MI types (T1MI, T2MI) and GCA-related MI (within 3 months of GCA flare) were analyzed.
Main Results:
- 13 MI cases were identified in 251 GCA patients (2.4% of cohort), matched with 65 controls.
- GCA-related MI occurred in 6 cases, predominantly as type 2 MI (T2MI) (80%), often triggered by GCA diagnosis (75%).
- GCA-unrelated MI were mostly type 1 MI (T1MI), associated with higher cumulative prednisone doses (p=0.032). One-year survival was similar between groups.
Conclusions:
- GCA-related MI are primarily T2MI, likely driven by systemic inflammation rather than direct coronary artery inflammation.
- GCA-unrelated MI are predominantly T1MI, linked to underlying atherothrombotic coronary artery disease.
- Understanding these distinctions is vital for managing cardiovascular risk in GCA patients.
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