Acute myocardial infarction and antiphospholipid syndrome: an updated systematic review and meta-analysis

Antiphospholipid syndrome (APS) is an autoimmune condition associated with an increased risk of thrombosis, myocardial infarction, strokes, recurrent miscarriages, and other cardiovascular events. Acute myocardial infarction (AMI) is a severe, potentially fatal, but yet uncommon complication of APS. This comprehensive systematic review, the largest to date, aims to explore the occurrence, clinical presentations, and outcomes of AMI in individuals with APS from inception to March 2025, highlighting the evolution of management and outcomes over time.

We searched through PubMed, Scopus, Web of Science, and Cochrane Central Register from inception to March 2025 in order to find case studies, series, and reports of AMI in individuals diagnosed with APS. Data were analysed quantitatively with continuous variables presented as means ± standard deviations and categorical data as frequencies or percentages.

Our review included 108 cases of AMI complicating APS, with 47 cases of primary APS, and 60 cases to secondary APS due to systemic lupus erythematosus. The average age at diagnosis was 36.37 ± 13.95 years. Among subjects, 36 had no history of thromboembolic events (challenging the assumption that previous thrombosis predicts cardiac complications), 34 had deep vein thrombosis, and 10 experienced cardiac-related thromboembolic events. The most common presentation of AMI in subjects with APS was ST-elevation in 90 subjects (83% of cases). The median activated partial thromboplastin time was 54 s (interquartile range: 42-84 s). Thrombocytopenia was observed in 23 cases, while 11 cases had thrombocytosis. Positive results for antiphospholipid antibodies included anticardiolipin antibody in 75 cases, lupus anticoagulant in 60 cases, and anti-β2 glycoprotein I in 25 cases. The overall prognosis was favourable, with a survival rate of 93.5% (101 individuals survived), 7 deaths, and 15 recurrent AMI episodes (13.8% of cases).

This comprehensive systematic review calls attention to the importance of considering APS as a potential risk factor for AMI, particularly in younger adults without typical cardiovascular risk factors, yet it carries a more favourable prognosis than previously thought. The findings highlight the high prevalence of thrombotic events, emphasise the importance of considering APS in young individuals with AMI, and suggest favourable outcomes in APS-associated AMI.