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Impact of Antiphospholipid Syndrome and/or Systemic Lupus Erythematosus on the Long-term Adverse Cardiovascular Outcomes in Patients After Percutaneous Coronary Intervention

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ABSTRACT

Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are 2 rare autoimmune disorders which commonly affect women. Several previous studies showed APS to have been evolved from SLE. Secondary APS often coexists with SLE. One common feature relating these 2 diseases are the antiphospholipid antibodies, which are found in most of the patients with APS and in approximately 30% to 40% of patients with SLE, among which, about 10% develop APS. The leading cause of death in these patients is from cardiovascular disease due to accelerated atherosclerosis, which often progresses more rapidly, compared with the general population. However, the impact of APS and/or SLE on the cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) is controversial. Therefore, to solve this issue, we aim to compare the long-term (≥1 year) adverse cardiovascular outcomes after PCI, in patients with APS and/or SLE, and those without these disorders.

Medline and EMBASE databases were searched for studies comparing the long-term adverse cardiovascular outcomes between SLE and non-SLE, APS and non-APS, or SLE + APS and non-SLE + non-APS after PCI. We calculated odd ratios (OR) and 95% confidence intervals (CIs) for these categorical variables, and the pooled analyses were performed with RevMan 5.3.

Seven studies consisting of a total of 253,436 patients (568 patients in the experimental group and 252,868 patients in the control group) were included in this meta-analysis. During a follow-up period of ≥1 year, mortality and myocardial Infarction (MI) were significantly higher in the experimental group (OR 2.02, 95% CI 1.63–2.49, P < 0.00001 and OR 1.59, 95% CI 1.23–2.05, P = 0.0004, respectively). Major adverse cardiac events and repeated revascularization were also significantly higher in the SLE/APS group (OR 2.40, 95% CI 1.42–4.03, P = 0.001 and OR 2.59, 95% CI 1.26–5.31, P = 0.01, respectively).

Antiphospholipid syndrome and SLE are associated with significantly higher long-term (≥1 year) adverse cardiovascular outcomes after PCI. However, because of the limited number of patients and researches done, and due to a larger percentage of heterogeneity observed among several subgroups, this analysis may not generate a powerful result.

No MeSH data available.


Related in: MedlinePlus

Forest plot showing the long-term results for mortality and myocardial infarction between the SLE/APS group and the control group after PCI. APS = antiphospholipid syndrome, PCI = percutaneous coronary intervention, SLE = systemic lupus erythematosus.
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Figure 2: Forest plot showing the long-term results for mortality and myocardial infarction between the SLE/APS group and the control group after PCI. APS = antiphospholipid syndrome, PCI = percutaneous coronary intervention, SLE = systemic lupus erythematosus.

Mentions: Results from this analysis showed that during a follow up of ≥1 year (less than 3 years), the adverse cardiovascular outcomes were significantly higher in the experimental group compared with the control group after PCI. A fixed-effect model was used to calculate the OR for mortality and MI during this follow-up period. Mortality and MI were significantly higher in the experimental group (OR 2.02, 95% CI 1.63–2.49, P < 0.00001 and OR 1.59, 95% CI 1.23–2.05, P = 0.0004, respectively). This result has been represented in Figure 2.


Impact of Antiphospholipid Syndrome and/or Systemic Lupus Erythematosus on the Long-term Adverse Cardiovascular Outcomes in Patients After Percutaneous Coronary Intervention
Forest plot showing the long-term results for mortality and myocardial infarction between the SLE/APS group and the control group after PCI. APS = antiphospholipid syndrome, PCI = percutaneous coronary intervention, SLE = systemic lupus erythematosus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998416&req=5

Figure 2: Forest plot showing the long-term results for mortality and myocardial infarction between the SLE/APS group and the control group after PCI. APS = antiphospholipid syndrome, PCI = percutaneous coronary intervention, SLE = systemic lupus erythematosus.
Mentions: Results from this analysis showed that during a follow up of ≥1 year (less than 3 years), the adverse cardiovascular outcomes were significantly higher in the experimental group compared with the control group after PCI. A fixed-effect model was used to calculate the OR for mortality and MI during this follow-up period. Mortality and MI were significantly higher in the experimental group (OR 2.02, 95% CI 1.63–2.49, P < 0.00001 and OR 1.59, 95% CI 1.23–2.05, P = 0.0004, respectively). This result has been represented in Figure 2.

View Article: PubMed Central - PubMed

ABSTRACT

Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are 2 rare autoimmune disorders which commonly affect women. Several previous studies showed APS to have been evolved from SLE. Secondary APS often coexists with SLE. One common feature relating these 2 diseases are the antiphospholipid antibodies, which are found in most of the patients with APS and in approximately 30% to 40% of patients with SLE, among which, about 10% develop APS. The leading cause of death in these patients is from cardiovascular disease due to accelerated atherosclerosis, which often progresses more rapidly, compared with the general population. However, the impact of APS and/or SLE on the cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) is controversial. Therefore, to solve this issue, we aim to compare the long-term (&ge;1 year) adverse cardiovascular outcomes after PCI, in patients with APS and/or SLE, and those without these disorders.

Medline and EMBASE databases were searched for studies comparing the long-term adverse cardiovascular outcomes between SLE and non-SLE, APS and non-APS, or SLE + APS and non-SLE + non-APS after PCI. We calculated odd ratios (OR) and 95% confidence intervals (CIs) for these categorical variables, and the pooled analyses were performed with RevMan 5.3.

Seven studies consisting of a total of 253,436 patients (568 patients in the experimental group and 252,868 patients in the control group) were included in this meta-analysis. During a follow-up period of &ge;1 year, mortality and myocardial Infarction (MI) were significantly higher in the experimental group (OR 2.02, 95% CI 1.63&ndash;2.49, P&#8202;&lt;&#8202;0.00001 and OR 1.59, 95% CI 1.23&ndash;2.05, P&#8202;=&#8202;0.0004, respectively). Major adverse cardiac events and repeated revascularization were also significantly higher in the SLE/APS group (OR 2.40, 95% CI 1.42&ndash;4.03, P&#8202;=&#8202;0.001 and OR 2.59, 95% CI 1.26&ndash;5.31, P&#8202;=&#8202;0.01, respectively).

Antiphospholipid syndrome and SLE are associated with significantly higher long-term (&ge;1 year) adverse cardiovascular outcomes after PCI. However, because of the limited number of patients and researches done, and due to a larger percentage of heterogeneity observed among several subgroups, this analysis may not generate a powerful result.

No MeSH data available.


Related in: MedlinePlus