Background/Purpose: Acute coronary syndrome (ACS) is one of the leading causes of death in the general population. We aimed at assessing the occurrence of ACS in patients with giant cell arteritis (GCA).
Methods: We retrospectively reviewed a population-based incidence cohort of patients with GCA diagnosed between 1950 and 2009 based on American College of Rheumatology 1990 GCA classification criteria. We also included patients ≥ 50 years of age with elevation of erythrocyte sedimentation rate or C-reactive protein and computed tomography, magnetic resonance imaging or positron emission tomography evidence of large vessel vasculitis involving ascending aorta and its branches. We compared this cohort with age, sex and calendar year matched cohort from the same population. All subjects were longitudinally followed through all available community medical records until death, migration or April 30, 2013. Data was collected on all documented episodes of ACS including Thrombolysis in Myocardial Infarction (TIMI) score. Cox models were used to compare the development of ACS between GCA and non-GCA cohort.
Results: We identified 245 patients in the GCA cohort and 245 age, sex and calendar year matched patients in the non-GCA cohort. No difference between the two cohorts was noted in overall ACS events [hazard ratio (HR) 0.74; confidence interval (95% CI) 0.44, 1.26]. No difference was noted in different types of ACS such as unstable angina [HR 0.41; 95% CI (0.16, 1.09)], non-ST elevation myocardial infarction (NSTEMI) [HR 0.85; 95% CI (0.39, 1.85)] and ST elevation myocardial infarction (STEMI) [HR 1.03; 95% CI (0.41, 2.62)]. Age at first ACS event after index date was similar in both cohorts. Time from index date to first ACS event was also similar in both cohorts. Overall TIMI scores for unstable angina and NSTEMI were similar in both cohorts. 10 of 26 GCA subjects (38%) underwent coronary angiography as opposed to 19 of 32 non-GCA subjects (59%) (p=0.11). Revascularization procedures including percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) were done less frequently in GCA [5 of 26 (19%)] than non-GCA subjects [16 of 32 (50%)] (p=0.015). Median length of hospital stay of first ACS event after index date was similar in both cohorts (4.5 vs 4 days). Post ACS complications including cardiogenic shock, persistent rest angina despite intervention, ventricular septal defect, mitral regurgitation and sustained ventricular arrhythmias were similar in both cohorts. 6 of 26 GCA subjects who had ACS experienced 10 recurrent events during 83 person-years of observation after the first episode as opposed to 6 of 32 non-GCA subjects who experienced 17 recurrent events during 138 person-years (rate ratio 1.00; 95% CI 0.44, 2.10)
Conclusion: There is no overall increased risk of acute coronary syndromes in patients with giant cell arteritis. Revascularization procedures are done less frequently in patients with giant cell arteritis. Overall length of hospital stay is not different in patients with giant cell arteritis who develop acute coronary syndrome.
Disclosure:
P. D. Udayakumar,
None;
A. K. Chandran,
None;
C. S. Crowson,
None;
K. J. Warrington,
None;
E. L. Matteson,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/acute-coronary-syndromes-in-patients-with-giant-cell-arteritis-a-population-based-retrospective-cohort-study/