Background/Purpose: Patients with autoimmune diseases (AID) have a high burden of cardiovascular disease leading to premature morbidity and mortality. But it is unclear if it is due to a higher prevalence of cardiovascular disease, to a worse case fatality or to a different management after an index event. The primary aim of the study is to assess the prognostic implications of the presence of AID both during the hospitalization and after discharge after an acute coronary syndrome (ACS). The secondary objectives included the assessment of the prevalence of AID in patients with ACS, their clinical profile and the management of this index event

Methods:  The study included consecutive patients admitted after ACS from January 2011 to December 2015 at the University Hospital Virgen de la Arrixaca, Murcia (Spain). For AID patients, in-hospital management and ACS presentation was compared to non-AID patients. We also compared in-hospital and major adverse events during follow-up (death, recurrent non-fatal myocardial infarction, stroke and major bleeding, between groups). A multivariate Cox regression model was performed to assess the independent role of the presence of AID in the occurrence of the events of interest.

Results: Of 2236 patients included with ACS, 78 had AID (3.3%): 24 rheumatoid arthritis, 10 inflammatory bowel disease, 7 ankylosing spondylitis, 6 psoriatic arthritis, 5 polymyalgia rheumatica, 2 systemic lupus erythematosus and 20 miscellanea. Mean age of AID patients was 67 ± 13 years and median evolution of the disease was 10 [4-14] years. Seventy percent of AID patients were taking corticosteroids, 50% disease modifying antirheumatic drugs, 22% non-steroidal anti-inflammatory drugs and 8 biological theraphy. No significant differences were found in clinical and demographics characteristics between groups except for a higher percentage of atrial fibrillation and chronic obstructive pulmonary disease in AID patients. Compared to non-AID patients, AID patients had similar clinical ACS presentation and no differences were found with respect to revascularization strategies or medical treatment at discharge. With respect to prognosis the two groups had comparable rates of adverse events during hospitalization (10% vs 10%, p=0.920) with no statistically significant differences in any single event studied. However after a follow-up of 397 [375-559] years, AID patients had higher rate of combined adverse events (44% vs 28% p<0,001). After multivariate adjustment the presence of AID was associated with increased total mortality (hazard ratio 2.1, 95% CI 1.2 to 3.7, p=0.008) and it was also a borderline risk factor for higher bleeding complications (hazard ratio 2.2, 95% CI 0.9 to 5.5). The presence of AID was not an independent risk factor for neither stroke or recurrent non-fatal myocardial infarction.

Conclusion:  The presence of AID did not change ACS presentation and clinical management. Although AID is not associated with worse outcomes during hospitalization it is independently linked to higher total mortality and a trend to an increased risk of major bleeding during follow-up

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-autoimmune-disease-in-the-management-and-prognosis-of-acute-coronary-syndrome/