Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Computed tomography angiography (CTA) provides prognostic information in patients with suspected but unknown coronary artery disease (CAD); subjects without plaque had no incident major cardiovascular events (MACE) at 52 months. In those with obstructive plaque (>50% stenosis) or significant plaque burden [segment involvement score (SIS)>5, or segment stenosis score (SSS)>5] incident MACE was noted in 69%, 75%, and 80% respectively at 52 months. We evaluated the contributions of demographic, traditional cardiac risk factors (CRF) and rheumatoid arthritis (RA)- associated variables on the risk of having obstructive plaque, SIS>5, or SSS>5 in 150 subjects with RA and no symptoms or diagnosis of CAD compared to 150 age and gender-matched controls.
Methods: Patients and controls underwent CTA; qualitative and quantitative plaque evaluation was carried out using a standard 15- coronary segment American Heart Association Model. Subjects with either obstructive plaque, or SIS>5, or SSS>5 where considered high-risk; the remainder were considered low-risk. Chi-square or Fisher’s exact tests evaluated the associations between binary variables and high-risk outcomes while simple logistic regression model was used for continuous variables. The Breslow-Day test assessed homogeneity of OR between two groups.
Results: A higher proportion of RA subjects were classified in the high-risk group: 23 (15.3%) vs. 8 (5.3%) in controls, OR (95%CI)=3.2 (1.4-7.4), p=0.004. Age was a significant determinant of high risk for the entire cohort (n=300) [OR=1.08 (1.04-1.13), p=0.0004], as well as for the RA group [OR=1.09 (1.04-1.15), p=0.001], but not the controls [OR=1.06 (0.98-1.15), p=0.14]. In RA patients, age>55 years was the best predictor of high-risk outcome, followed by male gender, diabetes, and hypertension (table 1); none of the RA-associated parameters predicted such outcome. No demographic or CRF predicted high-risk outcomes in controls. Significant interactions were observed between male gender and hypertension for high-risk outcomes in RA patients (p=0.024, and p=0.04 respectively).
Conclusion: Demographic and traditional CRF such as age, male gender, diabetes, and hypertension in decreasing significance predict obstructive or high burden coronary plaque by CTA in patients with RA and no symptoms or diagnosis of CAD. Male gender and hypertension differentially predict such outcomes in RA compared to controls.
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Table 1. Outcome= presence of obstructive plaque (>50% stenosis), or SSS>5, or SIS>5 (High-risk) vs. not (low-risk) |
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RA- univariate |
Controls-univariate |
RA vs. controls-differences in OR (Breslow-Day test)
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parameters |
OR |
p |
OR |
p |
p |
|
Age>(55) |
5.93 (2.1-17) |
0.0003 |
2.27 (0.5-9.9) |
0.3 |
0.29 |
|
Male |
5.62 (1.9-16.2) |
0.002 |
N/A* |
0.6 |
0.026 |
|
HTN |
2.9 (1.1-7.5) |
0.02 |
0.4 (0.09-2.3) |
0.47 |
0.04 |
|
DM |
4.2 (1.56-11.1) |
0.005 |
1.56 (0.3-8.2) |
0.6 |
0.3 |
|
Dyslipidemia |
0.4 (0.09-1.9) |
0.37 |
1.3 (0.3-5.5) |
0.7 |
0.25 |
|
smoking |
1.0 (0.2-4.86) |
1 |
N/A* |
0.6 |
0.27 |
|
FHx |
1.1 (0.12-9.95) |
1 |
0.4 (0.1-1.9) |
0.3 |
0.48 |
|
RA>5 years |
2.35 (0.75-7.3) |
0.14 |
– |
– |
– |
|
RF (+) & a-CCP (+) |
1 (0.2-4.8) |
1 |
– |
– |
– |
|
DAS28-3v>3.2 |
1.37 (0.56-3.3) |
0.5 |
– |
– |
– |
|
Erosions |
1.55 (0.57-4.2) |
0.47 |
– |
– |
– |
|
JRS |
1.43 (0.37-5.5) |
0.7 |
– |
– |
– |
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*N/A: OR not applicable due to presence of 0 cell value |
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Disclosure:
G. A. Karpouzas,
None;
J. Malpeso,
None;
T. Y. Choi,
None;
Y. Pak,
None;
M. Budoff,
None.
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