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Original Articles

Poor 1-Year Outcomes After Percutaneous Coronary Interventions in Systemic Lupus Erythematosus

Report From the National Heart, Lung, and Blood Institute Dynamic Registry

Kathleen Maksimowicz-McKinnon, DO; Faith Selzer, PhD; Susan Manzi, MD, MPH; Kevin E. Kip, PhD; Suresh R. Mulukutla, MD; Oscar C. Marroquin, MD; Thomas C. Smitherman, MD; Lewis H. Kuller, MD, Dr Ph; David O. Williams, MD and Mary Chester M. Wasko, MD, MSc

From the Division of Rheumatology (K.M.-M., S.M., M.C.M.W.), Division of Cardiology (S.R.M., O.C.M., T.C.M.), Department of Medicine; Department of Epidemiology (F.S., L.H.K.), the University of Pittsburgh, Pittsburgh, Pa; College of Nursing (K.E.K.), the University of South Florida, Tampa, Fla; and Division of Cardiology (D.O.W.), Department of Medicine, Rhode Island Hospital, Providence, RI.

Correspondence to Kathleen Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, 3500 Terrace St BST S718, Pittsburgh, PA 15213. E-mail mckinnonk{at}dom.pitt.edu

Received April 29, 2008; accepted October 15, 2008.

Background— Women with systemic lupus erythematosus (SLE) have premature and accelerated atherosclerosis. Although percutaneous coronary intervention (PCI) is used frequently to treat coronary artery disease in SLE, little is known regarding PCI outcomes immediately after PCI and after discharge.

Methods and Results— Baseline demographic, procedure-related, and adverse outcome data on consecutive patients undergoing PCI during 5 recruitment "waves" of the National Heart, Lung, and Blood Institute Dynamic Registry across 23 clinical centers were collected. SLE patients (n=28) were compared with non-SLE patients (n=3385). SLE patients were younger and more often female in comparison with non-SLE patients undergoing PCI. SLE patients were less likely than non-SLE patients to have hyperlipidemia but had a similar prevalence of hypertension, diabetes mellitus, and tobacco use. The prevalence of multivessel disease was similar between groups. Initial intervention success (by angiographic definition) was not significantly different between groups. At 1 year, SLE patients were more likely to experience a myocardial infarction (15.6% versus 4.8%, P=0.01) and more often required repeat PCI (31.3% versus 11.8%, P=0.009) than non-SLE patients, even after adjustment for important covariates.

Conclusions— SLE patients had significantly worse cardiovascular outcomes at 1 year than non-SLE patients. Even considering the small number of SLE patients, these differences were striking. Further study is warranted to explore other factors potentially accounting for this disparity, including SLE disease activity and duration, presence of hypercoagulable state, and immunosuppressive therapy.

Key Words: angioplasty • catheterization • restenosis • revascularization • systemic lupus erythematosus

Jane A. Leopold, MD, handled this manuscript.