Volume 31 Issue 3 - January 6, 2017 PDF
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Outcomes of Percutaneous Coronary Intervention in Patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus: An 11-year Nationwide Cohort Study
Chao-Han Lai1,*, Wu-Wei Lai1, Meng-Jiun Chiou2, Wei-Chieh Lin3, Yu-Jen Yang1, Chung-Yi Li2, Liang-Miin Tsai3
1 Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2 Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
3 Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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【105 Ta-You Wu Memorial Award】Special Issue

Patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have an increased risk of developing coronary atherosclerosis. However, the impact of RA and SLE on the outcomes in patients undergoing percutaneous coronary intervention (PCI) remains largely underdetermined. Using the National Health Insurance Research Database of Taiwan, we identified 171,547 adult patients who underwent first-time PCI between 2000 and 2010. Among these patients, 525 had established RA, and 211 had SLE. We found that after adjustment for patient characteristics and procedural variables, RA (odds ratio [OR]=1.73, 95% confidence interval [CI] 1.11-2.68) and SLE (OR=3.81, 95% CI 2.02-7.16) were both independent predictors of in-hospital mortality. During long-term follow-up, RA was independently associated with overall mortality (hazard ratio [HR]=1.55, 95% CI 1.35-1.79), ischemic events (HR=1.18, 95% CI=1.01-1.39) and major adverse cardiac events (MACE; HR=1.20, 95% CI=1.07-1.34) whereas SLE was independently associated with overall mortality (HR=2.20, 95% CI 1.74-2.78), repeat revascularization (HR=1.27, 95% CI 1.02-1.58) and MACE (HR=1.47, 95% CI=1.24-1.75). This study recognizes the inherent risks associated with RA and SLE in patients undergoing PCI and highlights the necessity to improve the caring and secondary prevention strategies for these high-risk patients.
Figure. Kaplan–Meier estimates of (A) overall survival, (B) freedom from ischemic events, (C) freedom from repeat revascularization and (D) freedom from any MACE in patients without autoimmune diseases (control group), patients with RA and patients with SLE in the PCI cohort of Taiwan, 2000–2010.
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