Cerebrovascular Accidents (CVA) in Giant Cell Arteritis: Identification of Predictive Factors from the ARTESER Registry

Adrián Martín-Gutiérrez¹, Juan Molina-Collada², Marta Domínguez-Álvaro³, Rafael Benito Melero-Gonzalez⁴, Elisa Fernández-Fernández:⁵, Maite Silva-Diaz⁶, Jesús Alejandro Valero⁷, Ismael Gonzalez⁸, Julio Sánchez-Martín⁹, Javier Narvaez-García¹⁰, Itziar Calvo¹¹, Vicente Aldasoro¹², lydia Abasolo Alcazar¹³, ALBERTO MARIANO RUIZ ROMAN¹⁴, Javier Loricera¹⁵, Santos Castañeda¹⁶, Clara Molina Almela¹⁷, María Alcalde Villar:¹⁸, Antonio Juan-Mas¹⁹ and Ricardo Blanco-Alonso²⁰, ¹Hospital Universitario Marques de Valdecilla, IDIVAL, Renedo de Piélagos, Cantabria, Spain, ²Hospital General Universitario Gregorio Marañón, Madrid, Spain, ³Sociedad Española de Reumatología, Madrid, Spain, ⁴CHU Ourense, O Carballino, Spain, ⁵La Paz University Hospital, Alcalá de Henares, Madrid, Spain, ⁶Complejo Hospitalario Universitario A Coruña, A Coruña, Spain, ⁷Hospital Universitario Donosti. Donostia, Spain, Donosti, Spain, ⁸Complejo Asistencial Universitario de Leon, León, Spain, ⁹Hospital Universitario 12 de Octubre, Madrid, Spain, ¹⁰Hospital Universitario de Bellvitge, Barcelona, Spain, ¹¹Hospital Universitario de Basurto, Bilbao, Spain, ¹²Hospital Universitario de Navarra, Pamplona, Spain, ¹³IdISSC. HCSC, Madrid, Spain, ¹⁴Hospital Universitario Juan Ramón Jiménez, Huelva, Spain, ¹⁵Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ¹⁶Hospital Universitario de la Princesa, Madrid, Spain, ¹⁷Consorcio Hospital General Universitario de Valencia, Valencia, Comunidad Valenciana, Spain, ¹⁸Hospital Universitario Severo Ochoa Leganés, Madrid, Spain, Madrid, Spain, ¹⁹Rheumatology Department, Hospital Universitario Severo Ochoa Leganés, Madrid, Spain, Madrid, Cantabria, Spain, ²⁰Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Immunopathology group, Santander, Spain

Meeting: ACR Convergence 2024

Keywords: Cardiovascular, giant cell arteritis, risk factors, Stroke, Vasculitis

Session Information

Date: Saturday, November 16, 2024

Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster I

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: Giant cell arteritis (GCA) is the most common form of systemic vasculitis in the elderly and involves the large and medium-sized vessels. Cerebrovascular accidents (CVA) are one of the most feared ischemic complications, but its prevalence and associated factors remains understudied.
Our aim is to determine the prevalence and predictive factors of CVA in a large registry of patients with GCA.

Methods: ARTESER is a large Spanish multicentre registry supported by the Spanish Society of Rheumatology. It includes patients with GCA from across the entire country diagnosed between June 2013 and March 2019. The variables collected at diagnosis were demographics, clinical manifestations (including the occurrence and type of CVA), laboratory, temporal artery biopsy, and imaging findings (ultrasound, FDG-PET/CT, MRI, angiography, CT angiography). Patients with and without CVA were compared in a bivariate analysis. Multivariate logistic regression was performed to determine potential predictive factors of CVA.

Results: A total of 1540 patients with GCA were included for analysis (mean age 77.1 years, 70% females). CVA occurred in 61 (3.96%), of whom 21 (34.4%) involved the carotid territory and 38 (62.3%) the vertebrobasilar territory. Demographics, clinical and imaging findings in patients with and without CVA is shown in Figure 1. The risk of death during follow-up was significantly higher in patients with CVA (18% vs 8.8%; p=0.014) and patients with CVA received significantly higher mean prednisone (mg) dose at diagnosis (433.9 vs 216; p< 0.001) and cumulative prednisone dose during follow-up (11203.9 vs 8194.1; p< 0.001. In the multivariate analysis (Figure2) the presence of concomitant visual manifestations (OR 2.598; 95% CI 1.345 – 5.015) was the only clinical variable associated with CVA. On the other hand, the cranial-GCA phenotype (OR 0.402; 95% CI 0.203 – 0.799) was associated with a reduced risk of CVA.

Conclusion: The prevalence of CVA in patients with GCA is low, but increases the risk of mortality. Visual manifestations were the only clinical factor associated with increased risk of CVA, whereas the cranial-GCA phenotype is associated with a reduced risk of CVA.

Abbreviations (in alphabetical order): ACR: American College of Rheumatology; BMI: body mass index; CRP: C-reactive protein; CT: computerized tomography; ESR: erythrocyte sedimentation rate; GCA: giant cell arteritis; IQR: interquartile range; LV: large vessel; n: number; SD: standard deviation; US: ultrasound.

Abbreviations (in alphabetical order): OR: Odds ratio; GCA: giant cell arteritis

Disclosures: A. Martín-Gutiérrez: None; J. Molina-Collada: None; M. Domínguez-Álvaro: None; R. Melero-Gonzalez: None; E. Fernández-Fernández:: None; M. Silva-Diaz: None; J. Valero: None; I. Gonzalez: None; J. Sánchez-Martín: None; J. Narvaez-García: None; I. Calvo: None; V. Aldasoro: None; l. Abasolo Alcazar: None; A. RUIZ ROMAN: None; J. Loricera: AstraZeneca, 2, 6, Celgene, 2, 6, Eli Lilly, 5, Janssen, 5, Merck/MSD, 2, 5, 6, Novartis, 12, Formation/Congress attendance, Pfizer, 5, Roche, 2, 5, 6, UCB, 2, 5, 6; S. Castañeda: Bristol-Myers Squibb(BMS), 2, 6, Eli Lilly, 2, 6, Merck/MSD, 2, 5, 6, Pfizer, 5, Roche, 2, 6, UCB, 2, 5; C. Molina Almela: None; M. Alcalde Villar:: None; A. Juan-Mas: None; R. Blanco-Alonso: AbbVie, 2, 5, 6, Bristol-Myers Squibb, 2, 6, Galapagos, 6, Janssen, 2, 6, Lilly, 2, 6, MSD, 2, 5, 6, Pfizer, 2, 6, Roche, 2, 5, 6.

To cite this abstract in AMA style:

Martín-Gutiérrez A, Molina-Collada J, Domínguez-Álvaro M, Melero-Gonzalez R, Fernández-Fernández: E, Silva-Diaz M, Valero J, Gonzalez I, Sánchez-Martín J, Narvaez-García J, Calvo I, Aldasoro V, Abasolo Alcazar l, RUIZ ROMAN A, Loricera J, Castañeda S, Molina Almela C, Alcalde Villar: M, Juan-Mas A, Blanco-Alonso R. Cerebrovascular Accidents (CVA) in Giant Cell Arteritis: Identification of Predictive Factors from the ARTESER Registry [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/cerebrovascular-accidents-cva-in-giant-cell-arteritis-identification-of-predictive-factors-from-the-arteser-registry/. Accessed .

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