Division of Cardiology, Providence St. Peter Hospital, Olympia, WA, USA.
Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK.
Rheumatology (Oxford). 2020 Sep 1;59(9):2512-2522. doi: 10.1093/rheumatology/kez639.
Patients with autoimmune rheumatic disease (AIRD) are at an increased risk of coronary artery disease. The present study sought to examine the prevalence and outcomes of AIRD patients undergoing percutaneous coronary intervention (PCI) from a national perspective.
All PCI-related hospitalizations recorded in the US National Inpatient Sample (2004-2014) were included, stratified into four groups: no AIRD, RA, SLE and SSc. We examined the prevalence of AIRD subtypes and assessed their association with in-hospital adverse events using multivariable logistic regression [odds ratios (OR) (95% CI)].
Patients with AIRD represented 1.4% (n = 90 469) of PCI hospitalizations. The prevalence of RA increased from 0.8% in 2004 to 1.4% in 2014, but other AIRD subtypes remained stable. In multivariable analysis, the adjusted odds ratio (aOR) of in-hospital complications [aOR any complication 1.13 (95% CI 1.01, 1.26), all-cause mortality 1.32 (1.03, 1.71), bleeding 1.50 (1.30, 1.74), stroke 1.36 (1.14, 1.62)] were significantly higher in patients with SSc compared with those without AIRD. There was no difference in complications between the SLE and RA groups and those without AIRD, except higher odds of bleeding in SLE patients [aOR 1.19 (95% CI 1.09, 1.29)] and reduced odds of all-cause mortality in RA patients [aOR 0.79 (95% CI 0.70, 0.88)].
In a nationwide cohort of US hospitalizations, we demonstrate increased rates of all adverse clinical outcomes following PCI in people with SSc and increased bleeding in SLE. Management of such patients should involve a multiteam approach with rheumatologists.
自身免疫性风湿病 (AIRD) 患者罹患冠状动脉疾病的风险增加。本研究旨在从全国角度探讨接受经皮冠状动脉介入治疗 (PCI) 的 AIRD 患者的患病率和结局。
纳入美国国家住院患者样本（2004-2014 年）中所有与 PCI 相关的住院治疗，分为四组：无 AIRD、类风湿关节炎 (RA)、系统性红斑狼疮 (SLE) 和系统性硬皮病 (SSc)。我们检查了 AIRD 亚型的患病率，并使用多变量逻辑回归 [比值比 (OR) (95%CI)] 评估其与住院期间不良事件的相关性。
AIRD 患者占 PCI 住院患者的 1.4%（n=90469）。2004 年 RA 的患病率为 0.8%，2014 年增至 1.4%，但其他 AIRD 亚型保持稳定。多变量分析显示，住院期间并发症的调整比值比（aOR）[任何并发症 1.13（95%CI 1.01，1.26），全因死亡率 1.32（1.03，1.71），出血 1.50（1.30，1.74），卒 1.36（1.14，1.62）]在 SSc 患者中显著高于无 AIRD 患者。SLE 组和 RA 组与无 AIRD 患者相比，并发症无差异，但 SLE 患者出血的可能性更高[aOR 1.19（95%CI 1.09，1.29）]，RA 患者全因死亡率的可能性更低[aOR 0.79（95%CI 0.70，0.88）]。
在一项美国全国住院患者队列研究中，我们发现在 SSc 患者中，PCI 后所有不良临床结局的发生率增加，而 SLE 患者的出血风险增加。此类患者的管理应涉及多团队方法，包括风湿病学家。
