Abstract 2896: Revascularization Improves Survival Compared with Medical Therapy in Patients with Rheumatologic Disease and Coronary Artery Disease
Background: Patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) and coronary artery disease (CAD) may be at increased risk for poor outcomes after revascularization procedures due to inflammation and immunosuppression. There are no studies comparing revascularization [percutaneous coronary intervention (PCI) or coronary artery bypass (CABG)] with medical therapy in RA or SLE patients with CAD.
Methods: Patients in the Duke Databank for Cardiovascular Disease with a diagnosis of either SLE (N=424) or RA (n=389) were identified and grouped according to treatment modality within 30 days post-cath (medical therapy vs. PCI vs. CABG). After adjustment for confounders and propensity to undergo medical therapy, PCI, or CABG, the association between treatment modality and long-term survival was determined using Cox proportional hazards regression modeling.
Results: Patients who underwent PCI had less severe CAD and were less likely to have cardiac risk factors, medical comorbidities, and congestive heart failure and had less severe CAD than those treated with medical therapy or CABG. After adjustment for patient differences and treatment propensity, PCI and CABG were associated with significantly improved survival over medical therapy (Figure⇓).
Conclusions: Revascularization (PCI or CABG) was associated with significantly improved survival compared with medical therapy in this cohort of RA and SLE patients. This suggests that revascularization should be aggressively considered in these patients, and concerns over poor outcomes from PCI or CABG may be unfounded.