Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Lupus Sci Med. 2021 Jul;8(1). doi: 10.1136/lupus-2021-000515.
Patients with SLE have increased risk of myocardial infarction (MI). Few studies have investigated the characteristics of SLE-related MIs. We compared characteristics of and risk factors for MI between SLE patients with MI (MI-SLE), MI patients without SLE (MI-non-SLE) and SLE patients without MI (non-MI-SLE) to understand underlying mechanisms.
We identified patients with a first-time MI in the Karolinska SLE cohort. These patients were individually matched for age and gender with MI-non-SLE and non-MI-SLE controls in a ratio of 1:1:1. Retrospective medical file review was performed. Paired statistics were used as appropriate.
Thirty-four MI-SLE patients (88% females) with a median age of 61 years were included. These patients had increased number of coronary arteries involved (p=0.04), and ≥50% coronary atherosclerosis/occlusion was numerically more common compared with MI-non-SLE controls (88% vs 66%; p=0.07). The left anterior descending artery was most commonly involved (73% vs 59%; p=0.11) and decreased (<50%) left ventricular ejection fraction occurred with similar frequency in MI-SLE and MI-non-SLE patients (45% vs 36%; p=0.79). Cardiovascular disease (44%, 5.9%, 12%; p<0.001) and coronary artery disease (32%, 2.9%, 0%; p<0.001), excluding MI, preceded MI/inclusion more commonly in MI-SLE than in MI-non-SLE and non-MI-SLE patients, respectively. MI-SLE patients had lower plasma albumin levels than non-MI-SLE patients (35 (29-37) vs 40 (37-42) g/L; p=0.002).
In the great majority of cases, MIs in SLE are associated with coronary atherosclerosis. Furthermore, MIs in SLE are commonly preceded by symptomatic vascular disease, calling for attentive surveillance of cardiovascular disease and its risk factors and early atheroprotective treatment.
患有系统性红斑狼疮（SLE）的患者发生心肌梗死（MI）的风险增加。很少有研究调查与 SLE 相关的 MI 的特征。我们比较了 MI 合并 SLE 患者（MI-SLE）、MI 不合并 SLE 患者（MI-non-SLE）和不合并 MI 的 SLE 患者（non-MI-SLE）之间的特征和 MI 的危险因素，以了解潜在的发病机制。
我们在 Karolinska SLE 队列中确定了首次发生 MI 的患者。这些患者按照年龄和性别与 MI-non-SLE 和 non-MI-SLE 对照组以 1:1:1 的比例进行了个体匹配。回顾性地对医疗档案进行了审查。适当使用配对统计方法。
共纳入 34 例 MI-SLE 患者（88%为女性），中位年龄为 61 岁。这些患者的冠状动脉受累血管数量增加（p=0.04），与 MI-non-SLE 对照组相比，≥50%的冠状动脉粥样硬化/闭塞的发生率更高（88% vs 66%；p=0.07）。最常受累的是前降支（73% vs 59%；p=0.11），MI-SLE 和 MI-non-SLE 患者的左心室射血分数降低（<50%）的发生率相似（45% vs 36%；p=0.79）。MI-SLE 患者的心血管疾病（44%、5.9%、12%；p<0.001）和冠状动脉疾病（32%、2.9%、0%；p<0.001）的发生率均高于 MI-non-SLE 和 non-MI-SLE 患者，且这些疾病均发生在 MI 之前/纳入 MI-SLE 队列之前。与 non-MI-SLE 患者相比，MI-SLE 患者的血浆白蛋白水平更低（35（29-37）vs 40（37-42）g/L；p=0.002）。
在大多数情况下，SLE 中的 MI 与冠状动脉粥样硬化有关。此外，SLE 中的 MI 常发生在有症状的血管疾病之前，这需要对心血管疾病及其危险因素进行密切监测，并尽早进行动脉粥样硬化保护治疗。
