AB1315 BIOLOGICAL THERAPY CAN IMPROVE CORONARY ARTERY LESIONS AND IMMUNOTHERAPY REDUCES THE OCCURRENCE RATE OF MACE IN TAKAYASU ARTERITIS PATIENTS WITH CORONARY ARTERY LESIONS
Authors: L. Pan, J. Du, H. Liao
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Takayasu arteritis(TA)can involve coronary artery lesions. Previous studies have shown that the incidence of TA complicated with coronary artery lesion is 3.6%-53.2%[1,2],The incidence of acute myocardial infarction is 5.9%-12.06%[3, 4]. Tocilizumab treatment could significantly improved TA with coronary artery lesion[5]. But,the pathogenesis of takayasu arteritis complicated with coronary artery lesion is very complex, and the influencing factors are still unclear, and there is no optimal treatment strategy for these patients.If TA with concurrent coronary artery involvement is not promptly identified, it may lead to major adverse cardiac events (MACE). <h3>Objectives:</h3> This study aimed to investigate the influencing factors of pharmacologic improvement of TA with coronary artery lesion, as well as to conduct a prognosis analysis. <h3>Methods:</h3> This retrospective study enrolled 188 TA patients. All patients were divided into two groups according to the absence or presence of coronary artery lesion. This study compared baseline general information, traditional risk factors, disease activity, treatment modalities, changes in imaging before and after treatment and recorded MACE between the two groups. Logistic regression and cox regression were employed to determine the risk factors for coronary artery lesions in TA patients and factors influencing prognosis. <h3>Results:</h3> The incidence of coronary artery involvement in TA is 48.40%.Logistic regression analysis showed that hypertension (<i>p</i>=0.002, OR 2.298,95%CI:1.499-5.720) and hyperlipidemia(<i>p</i>&lt;0.001, OR 13.706,95%CI:3.796-49.486).However, type I in TA patients was less likely to develop coronary artery disease (<i>p</i>=0.046, OR0.278 95% CI:0.079-0.980).We conducted follow-up with 44 TAK patients who underwent pre- and post-contrast coronary CTA, and compared and analyzed the occurrence of MACE.Cox regression analysis showed coronary artery lesions in TA patients of Type IIb tend to improve more easily (<i>p</i>=0.005, HR 4.559,95%CI:1.563-13.293)and tocilizumab therapy can significantly improve coronary artery lesions in TA patients.(<i>p</i>=0.006,HR 4.284,95%CI:1.509-12.158). In terms of improvement in coronary artery lesions, the most significant changes were observed in the opening of the left main trunk, proximal narrowing of the anterior descending branch, and improvements in concentric lesions.The incidence of MACE after immunotherapy decreased from 33.3% within six months to 2.33%. The occurrence time of MACE extended from 3.50 (1.00, 6.75) months before treatment to 15.00 (10.00, 49.00) (p=0.008)months after treatment. <h3>Conclusion:</h3> Hypertension and hyperlipidemia are risk factors for the development of coronary artery lesions in TA. Tocilizumab significantly improves coronary artery lesions in TA patients, with coronary artery lesions of Numano Type IIb more easily amenable to improvement. Regular immunotherapy reduces the occurrence rate of MACE and significantly prolongs the time to MACE in TA patients with concurrent coronary artery lesions. <h3>REFERENCES:</h3> [1] Li J, Sun F, Chen Z, Yang Y, Zhao J, Li M, Tian X, Zeng X: The clinical characteristics of Chinese Takayasu's arteritis patients: a retrospective study of 411 patients over 24 years. Arthritis Res Ther 2017, 19(1):107. [2] Kang EJ, Kim SM, Choe YH, Lee GY, Lee KN, Kim DK: Takayasu arteritis: assessment of coronary arterial abnormalities with 128-section dual-source CT angiography of the coronary arteries and aorta. Radiology 2014, 270(1):74-81. [3] Yuan SM, Lin HZ: Coronary artery involvements in Takayasu arteritis: systematic review of reports. Gen Thorac Cardiovasc Surg 2020, 68(9):883-904. [4] Huo J, Wang B, Yu L, Gao D, Cheng R, Wang J, Zhou X, Tian T, Gao L: Clinical characteristics and outcomes in patients with Takayasu arteritis coexisting with myocardial ischemia and neurological symptoms: A multicenter, long-term, follow-up study. Front Cardiovasc Med 2022, 9:948124. [5] Pan L, Du J, Liu J, Liao H, Liu X, Guo X, Liang J, Han H, Yang L, Zhou Y: Tocilizumab treatment effectively improves coronary artery involvement in patients with Takayasu arteritis. Clin Rheumatol 2020, 39(8):2369-2378. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>