RESEARCH - Poor outcomes after acute MI in SLE

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J Rheumatol. 2009 Jan 22. [Epub ahead of print]

Poor Outcomes After Acute Myocardial Infarction in Systemic Lupus Erythematosus.

Shah MA, Shah AM, Krishnan E.

From the Department of Internal Medicine, University of Kentucky,

Lexington, Kentucky; and Division of Immunology and Rheumatology,

Department of Medicine, Stanford University, Palo Alto, California,

USA.

OBJECTIVE: Systemic lupus erythematosus (SLE) is associated with

higher risk for acute myocardial infarction (MI); but the

post-infarction outcomes among these patients are unknown. Our

objective was to compare post-acute MI outcomes in patients with SLE

to those with diabetes mellitus (DM) and those with neither condition.

METHODS: We analyzed the risk for prolonged hospitalization and

in-hospital mortality following acute MI in the 1993-2002 US

Nationwide Inpatient Sample. We used logistic regression to calculate

odds ratios (OR) for prolonged hospitalization and proportional

hazards regression to calculate hazard ratios (HR) for in-hospital

mortality with and without adjustments for age, sex, race/ethnicity,

socioeconomic status, and presence of congestive heart failure.

RESULTS: For the SLE (n = 2192), DM (n = 236,016), SLE/DM (n = 474),

and control (n = 667,956) groups, the in-hospital mortality rates were

8.3%, 6.2%, 5.7%, and 4.7%, respectively. In multivariable regression

models, all 3 disease groups had higher adverse outcome risk compared

to control. The OR for prolonged hospitalization was higher for those

with SLE (OR 1.48, 95% CI 1.32-1.79) compared to those with DM (OR

1.30, 95% CI 1.28-1.32). A similar pattern was observed for hazard

ratios for in-hospital mortality as well (SLE, HR 1.65, 95% CI

1.33-2.04; DM, HR 1.11, 95% CI 1.07-1.14).

CONCLUSION: SLE, like DM, increases risk of poor outcomes after acute

MI. These patients need to be triaged appropriately for aggressive

care.

PMID: 19208594

http://www.ncbi.nlm.nih.gov/pubmed/19208594

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