Study on SLE and MACE Risk

According to a new study, patients with systemic lupus erythematosus (SLE) have an elevated risk of major adverse cardiac events (MACE) within one month following surgery, comparable to diabetes controls but greater than non-diabetic controls. After controlling for pre-operative Revised Cardiac Risk Index (RCRI) scores, this risk normalizes, indicating that SLE patients are at a higher risk of MACE due to underlying comorbidities such as cardiovascular disease. The study was conducted by Sebastian Bruera and team.

This research work was presented at the American College of Rheumatology (ACR) Convergence 2021 on November 6th, 2021.

Study Goals and Methodology

The goal of this study was to evaluate the risk of MACE in patients with SLE having moderate to high-risk non-cardiac operations compared to patients with and without diabetes in a control group. The Optum Clinformatics Data Mart was used to gather de-identified administrative data on individuals who underwent noncardiac surgery between 2007 and 2020. Patients who had low-risk treatments, such as eye surgery or basic skin procedures, were not included. The researchers defined an SLE cohort, with and without diabetes from the remaining surgical patient data pool. Patients with SLE were matched by age and gender to patients in the diabetes and non-diabetes groups.

Main Outcome and Analysis

MACE (defined as mortality, ischemic stroke, myocardial infarction, or pulmonary embolism according to International Classification of Diseases [ICD]) within 1 month of surgery was the main outcome. After correcting for RCRI score and race, multivariable conditional logistic regression was performed to assess the chances of the primary outcome across the three cohorts. Multivariable logistic regression models for MACE in SLE patients included the RCRI score, age, race, gender, and SLE disease activity as measured by the Garris index.

Results

A total of 4,750 SLE patients were included, as well as 484,986 non-diabetic controls and 496,381 diabetes controls. After matching, no significant variations in MACE rates were seen between SLE and diabetic individuals. Without correction, SLE patients exhibited a higher incidence of MACE compared to non-diabetic controls; however, after controlling for RCRI scores, the connection became non-significant. Higher RCRI scores, longer age, and non-white race were related with an increased risk of MACE in SLE patients, but not gender, pre-operative cardiac tests, or SLE disease activity.

Conclusion

In conclusion, the findings of this study suggest that SLE, regardless of illness severity, increases the risk of MACE, which is mediated by pre-existing cardiovascular disease.

Reference

Bruera S, Lei X, Blau B, et al. Increased risk of major adverse cardiac events in patients with systemic lupus erythematosus after non-cardiac surgery. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 128.