Background/Purpose: Ischemic heart disease (IHD) is classically considered a disease of older men. However, 10% of myocardial infarctions occur in patients aged <45; also, in up to 25% of cases, these young patients are females. Classic atherosclerosis represents the most common etiology in young patients with IHD; additional causes include coronary vasospasm, coronary artery dissection, or vasculitis. Takayasu arteritis (TA) is a rare, large vessel vasculitis characterized by granulomatous inflammation of the aorta and its major branches, usually occurring in female patients aged ≤40. Purpose of this study was to evaluate the prevalence of TA in young women presenting with acute IHD in the Emergency Department.

Methods: We evaluated the hospital records of 172,790 consecutive young female patients (aged <45), who accessed the Emergency Department of our institution, a University Hospital serving a population of 1.5 million, over 8 consecutive years (2007-2015). The diagnosis at discharge was confirmed by either outpatient clinic or a telephone interview. Diagnosis of TA was established based on the 1990 ACR criteria.

Results: We identified 2,090 women aged <45 who presented with chest pain, dyspnea, palpitations, angina, heart failure, or cardiac arrest. Of these patients, 40 had IHD, as confirmed by elevated serum troponin T and compatible electrocardiographic changes. Seven additional patients, who died either before or shortly after accessing the Urgent Care department and in whom autopsy was not performed, were excluded from the study since their cause of death was not univocally identifiable. The etiology of IHD was ‘classic’ atherosclerosis in 24 cases, TA in 4 cases, vasospasm and sympathomimetic drug abuse in 3 cases each, coronary artery dissection and microvascular angina in 2 cases each, Takotsubo and radiation-induced cardiomyopathy in 1 case each.

Conclusion: In spite of an extremely low incidence in the general population (1-3 new cases/million/year in Europe or the United States), TA accounted for 10% of cases of acute IHD in female patients aged <45 in our study group. Since our Institution serves a population of 1.5 million, and coronary involvement may appear in up to a third of TA patients, the number of observed cases is compatible with the a priori expectations based on TA estimated incidence. Although ‘classic’ atherosclerosis remains the leading cause of IHD, in our study cohort TA was more frequent a cause than vasospasm and drug abuse. This finding is important, as while the latter two etiologies are commonly considered in young patients with cardiac ischemia, TA is very likely to be overlooked. Our data indicate that TA is not infrequent in younger females presenting with acute IHD. The development of TA in a young woman marks the onset of a severe, chronic disease characterized by recurrences and significant morbidity and mortality in the most productive years of life. Thus, it is crucial that a diagnosis of TA is not overlooked in a young woman presenting with IHD, in order to provide optimal care of the patient besides the management of the acute event.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-takayasu-arteritis-in-young-women-presenting-with-acute-ischemic-heart-disease/