POS0779 MYOCARDIAL INFARCTIONS, SUBTYPES, LOCATIONS AND CORONARY ATHEROSCLEROSIS IN SLE - A COMPARATIVE STUDY WITH MATCHED CONTROLS
Authors: I. Samuelsson, I. Parodis, I. Gunnarsson, A. Zickert, C. Hofman-Bang, H. Wallén, E. Svenungsson
Journal: Annals of the Rheumatic Diseases (2021)

Background: Myocardial infarction (MI) is estimated to be 2- to 3-fold elevated in systemic lupus erythematosus (SLE) as compared to gender- and age-matched controls (1-2). Even though some risk factors have been purposed, mechanisms of increased MI incidence remains to be determined. Objectives: To explore underlying mechanisms, we compared MI characteristics and risk factors between SLE patients with MI (MI-SLE), MI patients without SLE (MI-nonSLE) and SLE patients without MI (nonMI-SLE). Methods: We performed retrospective medical file review including angiography and echocardiography reports in 34 MI-SLE patients, 34 MI-nonSLE patients and 34 nonMI-SLE patients – all individually matched for gender and age in a ratio of 1:1:1. Results: Median age was 61 years and 88% were females. MI-SLE patients had more coronary arteries involved (table 1; p=0.038), and ≥50% coronary atherosclerosis/occlusion at MI was numerically more common compared to MI-nonSLE controls (88% versus 66%; p=0.065). The left anterior descending artery was most frequently involved in both MI groups (73% versus 59%; p=0.11). Decreased (&lt;50%) left ventricular ejection fraction occurred with similar frequency (45% versus 36%; p=0.79) in MI-SLE patients compared to MI-nonSLE patients. Cardiovascular disease (CVD) (44%, 5.9%, 12%; p&lt;0.001) and coronary artery disease excluding MI (CAD, 32%, 2.9%, 0%; p&lt;0.001) preceded MI/inclusion more commonly in MI-SLE than in MI-nonSLE and nonMI-SLE patients, respectively. MI-SLE patients differed from nonMI-SLE patients through lower plasma albumin levels (35 (29-37) versus 40 (37-42) g/L; p=0.002) and longer disease duration (22 (14-32) versus 14 (6.3-24) years; p=0.038). Conclusion: We demonstrate that non-procedural MIs in SLE are in 88% of cases associated with significant coronary atherosclerosis. Increased prevalence of CAD prior MI and higher number of coronary arteries involved at MI, suggest accelerated coronary atherosclerosis in SLE patients. This calls for attentive surveillance of CVD and early atheroprotective treatment in this patients group. References: [1]Hak AE et al. Systemic lupus erythematosus and the risk of cardiovascular disease: Results from the nurses’ health study. Arthritis and rheumatism 2009;61:1396-402. [2]Fischer LM et. Effect of rheumatoid arthritis or systemic lupus erythematosus on the risk of first-time acute myocardial infarction. The American journal of cardiology 2004;93:198-200. Table 1. MI characteristics MI-SLE N total MI-nonSLE N total P-value ECG findings NSTEMI 23 (72%) 32 21 (66%) 32 1.0 STEMI Presence of atherosclerosis 9 (28%) 32 11 (34%) 32 0-VD 3 (12%) 26 10 (35%) 29 0.065 MI-CAD (≥1-VD) Number of involved arteries 23 (88%) 26 19 (66%) 29 0-VD 3 (12%) 26 10 (35%) 29 0.038 1-VD 13 (50%) 26 9 (31%) 29 ≥2-VD 10 (39%) 26 10 (35%) 29 Involvement of specific arteries LMCA 3 (12%) 26 0 (0%) 29 0.50 LAD 19 (73%) 26 17 (59%) 29 0.11 RCA 7 (27%) 26 9 (31%) 29 0.75 Cx 6 (23%) 26 6 (21%) 29 1.0 Left ventricular ejection fraction &lt;50% 13 (45%) 29 12 (36%) 33 0.79 ≥50% 16 (55%) 29 21 (64%) 33 0-VD = 0-Vessel disease. 1-VD = 1-Vessel disease. 2-VD = 2-Vessel disease. Cx = Circumflex artery. LAD = Left anterior descending artery. LMCA = Left main coronary artery. MI-CAD = MI with coronary artery disease. NSTEMI = Non-ST-elevation MI. RCA = Right coronary artery. STEMI = ST-elevation MI. Disclosure of Interests: Isak Samuelsson: None declared, Ioannis Parodis Grant/research support from: The author declare that he has no conflict of interest related to this work, Iva Gunnarsson Grant/research support from: The author declare that she has no conflict of interest related to this work, Agneta Zickert: None declared, Claes Hofman-Bang: None declared, Håkan Wallén Grant/research support from: The author declare that he has no conflict of interest related to this work, Elisabet Svenungsson Grant/research support from: The author declare that she has no conflict of interest related to this work