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Identification of Coronary Morphological Damage in Patients with Chronic Inflammatory Rheumatic Diseases
Elena Heras-Recuero1, Juan Antonio Martínez-López1,2, Macarena Garbayo-Bugeda3
1Division of Rheumatology, Fundación Jiménez Díaz, 28040 Madrid, Spain.
Insights
Patients with chronic inflammatory rheumatic diseases (CIRDs) have more extensive coronary artery disease (CAD), particularly in the mid-anterior descending and right posterior descending arteries. This underscores the need for enhanced cardiovascular monitoring in CIRD patients.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Medical Imaging
Background:
- Chronic inflammatory rheumatic diseases (CIRDs) are linked to accelerated atherosclerosis and increased coronary artery disease (CAD) risk.
- Understanding the specific patterns of CAD in CIRD patients is crucial for risk stratification and management.
Purpose of the Study:
- To compare the extent and location of coronary artery disease (CAD) lesions in patients with chronic inflammatory rheumatic diseases (CIRDs) versus non-CIRD controls.
- To identify specific coronary artery territories more frequently affected in CIRD patients.
Main Methods:
- Retrospective analysis of coronary angiography data from 66 CIRD patients (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis) and matched controls (2018-2022).
- Frequency matching of controls based on sex, age, diabetic status, and indication for coronary angiography (chronic or acute coronary syndrome).
Main Results:
- CIRD patients showed a significantly higher number of affected coronary arteries (2.03 vs. 1.56, p=0.03).
- The mid-anterior descending and right posterior descending arteries were more frequently involved in CIRD patients (OR 2.45, p=0.02 and OR 3.53, p=0.02, respectively).
- Revascularization procedures were more common in CIRD patients (OR 2.02, p=0.03).
Conclusions:
- Patients with CIRDs exhibit more extensive coronary artery disease (CAD) compared to non-CIRD individuals.
- Specific arteries, including the mid-anterior descending and right posterior descending arteries, are disproportionately affected in CIRD patients.
- These findings emphasize the necessity for intensified cardiovascular surveillance and early risk assessment in the CIRD population.
Abstract:
Objective: Patients with chronic inflammatory rheumatic diseases (CIRDs) have a higher incidence of coronary artery disease (CAD) due to accelerated atherogenesis. This study aimed to assess the extent and location of CAD lesions in CIRD patients compared to non-CIRD patients. Methods: A retrospective study was conducted on CIRD patients (rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) who underwent coronary angiography at Hospital Fundación Jiménez Díaz (Madrid, Spain) between 2018 and 2022. For each CIRD patient, at least two frequency-matched controls were selected based on sex, age (±2 years), diabetic status, and clinical indication for coronary angiography. The indications for coronary angiography in both groups were chronic coronary syndrome and acute coronary syndrome with or without ST elevation. Results: A total of 66 CIRD patients were included, with 42 (63.6%) women, and a median age of 66.6 years (range: 58.3-75.2). Compared to the controls, CIRD patients had a higher number of affected coronary arteries (2.03 vs. 1.56, p = 0.03). The mid-anterior descending artery and the right posterior descending artery were more frequently involved in CIRD patients than in controls (odds ratio [OR] of 2.45 and 3.53, respectively, p ≤ 0.02 for both comparisons). The frequency of coronary calcification was higher in CIRD patients, though the difference did not reach statistical significance (5 of 66 in CIRD patients vs. 3 of 140 in non-CIRD controls, OR of 3.74, p = 0.06). Revascularization was more commonly performed in patients with CIRD (50 of 66 vs. 85 of 140 in those without CIRD (OR: 2.02 [95% CI: 1.01-4.18]; p = 0.03). Conclusions: Patients with CIRD exhibit more extensive CAD, with a higher propensity for involvement inthe mid-anterior descending and right posterior descending arteries compared to patients without CIRD. These findings highlight the need for closer cardiovascular monitoring and early risk stratification in CIRD patients to improve the detection and management of CAD.
