Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Clin Exp Rheumatol. 2020 Nov-Dec;38(6):1118-1126. Epub 2020 Feb 14.
To identify the predictors of coronary involvement, and to determine the impact of coronary involvement on long-term outcomes in patients with Takayasu's arteritis (TAK).
This retrospective cohort study of TAK patients with coronary evaluation by angiography or computed tomography angiography was conducted in a tertiary center between 1990 and 2018. Risk factors for coronary involvement and predictors of overall survival, cardiovascular event-free survival, and relapse-free survival were investigated.
The median follow-up was 4.3 years (IQR 2.8-7.1). Out of 130 consecutive TAK patients, 71 (54.6%) had coronary involvement. Multivariate analysis revealed that age (OR: 1.537 per 10-year increase, 95% CI: 1.176-2.009, p=0.002) and type V angiographic classification (OR: 3.449, 95% CI: 1.600-7.437, p=0.002) were independent predictors of coronary involvement. Coronary involvement (HR: 8.358, 95% CI: 1.887-37.033, p=0.015), left ventricular systolic dysfunction (HR: 3.889, 95% CI: 1.467-10.311, p=0.006), and aortic regurgitation (HR: 3.373, 95% CI: 1.209-9.408, p=0.020) were independent predictors of overall survival. Furthermore, coronary involvement and baseline active disease were independently associated with increased major cardiovascular events (HR: 10.333, 95% CI: 2.326-45.906, p=0.017; HR: 7.084, 95% CI: 1.677-29.914, p=0.008, respectively) and relapse (HR: 5.186, 95% CI: 2.381-11.295, p<0.001; HR: 5.694, 95% CI: 2.022-16.031, p=0.001, respectively). No immunosuppressive therapy was independently associated with increased cardiovascular events (HR: 2.560, 95% CI: 1.181-5.550, p=0.002).
Coronary involvement is an important predictor of poor long-term outcomes in patients with TAK. Increasing age and type V angiographic classification can help to identify TAK patients with coronary involvement.
确定冠状动脉受累的预测因素，并确定冠状动脉受累对大动脉炎（TAK）患者长期结局的影响。
本研究回顾性分析了 1990 年至 2018 年在一家三级中心接受冠状动脉造影或计算机断层血管造影评估的 TAK 患者，探讨了冠状动脉受累的危险因素和总生存、无心血管事件生存和无复发生存的预测因素。
中位随访时间为 4.3 年（IQR 2.8-7.1）。130 例连续 TAK 患者中，71 例（54.6%）有冠状动脉受累。多因素分析显示，年龄（每增加 10 岁，OR：1.537，95%CI：1.176-2.009，p=0.002）和血管造影 V 型分类（OR：3.449，95%CI：1.600-7.437，p=0.002）是冠状动脉受累的独立预测因素。冠状动脉受累（HR：8.358，95%CI：1.887-37.033，p=0.015）、左心室收缩功能障碍（HR：3.889，95%CI：1.467-10.311，p=0.006）和主动脉瓣反流（HR：3.373，95%CI：1.209-9.408，p=0.020）是总生存的独立预测因素。此外，冠状动脉受累和基线活动期疾病与主要心血管事件（HR：10.333，95%CI：2.326-45.906，p=0.017；HR：7.084，95%CI：1.677-29.914，p=0.008）和复发（HR：5.186，95%CI：2.381-11.295，p<0.001；HR：5.694，95%CI：2.022-16.031，p=0.001）的增加有关。未接受免疫抑制治疗与心血管事件增加有关（HR：2.560，95%CI：1.181-5.550，p=0.002）。
冠状动脉受累是 TAK 患者长期预后不良的重要预测因素。年龄增加和血管造影 V 型分类有助于识别有冠状动脉受累的 TAK 患者。
