AB0453 CORONARY ARTERY DISEASES IN PATIENTS WITH ANTIPHOSPHOLIPID ANTIBODY SYNDROME: A RETROSPECTIVE COHORT STUDY IN CHINA
Authors: S. Zhang, L. Wang, Z. Shen, S. Zhang, M. Li
Journal: Annals of the Rheumatic Diseases (2020)

Background: Antiphospholipid syndrome (APS) is an autoimmune disorder caused by pathogenic antiphospholipid antibodies. Coronary artery disease as one of cardiac involvement of APS brings great challenges in clinical practice. Objectives: To identify the key demographic, clinical, angiography features, risk factors, and prognosis of patients presenting with coronary artery diseases in APS. Methods: We retrospectively analyzed patients who had been diagnosed with coronary artery disease induced by APS between January 1 st , 2012 and June 30 th , 2019, to study the clinical features, management, risk factors for prognosis, and long-term outcomes of patients. Results: Twenty-eight patients (50% female) with APS and coronary artery diseases were included, with average age 46.9 ± 14.4 years. Arterial thrombosis events (78.6%, n=22) were more common than venous events (42.9%, n=12) in this cohort. Twelve patients had stable CAD, while 14 patients had acute coronary syndrome. The most affected arteries were the anterior descending (60.9%), right coronary (39.1%), and circumflex (30.4%). More RCA stenosis (63.6% vs 16.7%, p=0.036) were observed in the primary APS group than in the secondary APS. The age and disease duration of patients differed among groups and was lower in the triple aPL positive group than in double- and single-aPL positive groups, without significant differences among different CAD manifestations. Thrombocytopenia, elevated creatinine, and elevated urea were the risk factors for poor prognosis. Conclusion: The coronary artery is an important target organ for APS. More RCA stenosis were observed in the primary APS group. APS-related CAD could endanger life and increase the mortality rate, with risk factors of thrombocytopenia, elevated creatinine, and elevated urea level. In addition to the routine use of anticoagulant and antiplatelet drugs, management of this group of patients is not well documented. The best treatment strategy still needs to be found and evaluated. References: [1]Mavrogeni SI, Sfikakis PP, Kitas GD, Kolovou G, Tektonidou MG. Cardiac involvement in antiphospholipid syndrome: The diagnostic role of noninvasive cardiac imaging. Semin Arthritis Rheum . 2016;45(5):611-616. [2]Denas G, Jose SP, Bracco A, Zoppellaro G, Pengo V. Antiphospholipid syndrome and the heart: A case series and literature review. Autoimmun Rev . 2015;14(3):214-222. [3]Cervera R, Piette JC, Font J, et al. Antiphospholipid syndrome: Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum . 2002;46(4):1019-1027. TABLE 1. Coronary artery disease assessment of the patients Total Types of APS pAPS (n=13 ) sAPS (n=15 ) p Coronary artery diseases sCAD (n, % ) 12, 42.9 6, 46.2 6, 40.0 .743 UA (n, % ) 2, 7.1 1, 7.7 1, 6.7 1.0 NSTEMI (n, % ) 5, 17.9 4, 30.8 1, 6.7 .153 STEMI (n, % ) 7, 25.0 2, 15.4 5, 33.3 .396 Other (n, % ) 2, 7.1 0, 0 2, 13.3 .484 Coronary artery thrombosis 17, 60.7 8, 61.5 9, 60.0 .934 ECHO ( n ) 26 13 13 LVEF (% ) 52.2±15.0 46.8±12.0 57.6±15.7 .09 Segmental ventricular wall motion abnormality 21, 80.8 11, 84.6 10, 76.9 1.00 Diastolic dysfunction 11, 42.3 5, 38.4 6, 46.1 1.00 Ventricular enlargement 13, 50.0 7, 53.8 6, 46.1 1.00 Atrial enlargement 14,53.8 7, 53.4 7, 53.4 1.04 CAG or CTA performance (n ) 23 11 12 LM stenosis (n, % ) 5, 21.7 3, 27.3 2, 16.7 .640 LAD stenosis (n, % ) 14, 60.9 6, 54.5 8, 66.7 .680 LCX stenosis (n, % ) 7, 30.4 3, 27.3 4, 33.3 1.00 RCA stenosis (n, % ) 9, 39.1 7, 63.6 2, 16.7 .036 aneurysm (n, % ) 1, 4.3 0, 0 1, 8.3 1.00 Figure 1. Cumulative survival function figure in APS patients with CAD Disclosure of Interests: : None declared