TY - JOUR
T1 - Outcomes of coronary artery bypass grafting in patients with inflammatory rheumatic diseases
T2 - An 11-year nationwide cohort study
AU - Lai, Chao Han
AU - Lai, Wu Wei
AU - Chiou, Meng Jiun
AU - Tsai, Liang Miin
AU - Wen, Jih Sheng
AU - Li, Chung Yi
N1 - Funding Information:
We studied the impact of RA, SLE, and ASp on patients undergoing CABG. Among patients undergoing CABG, those with RA had outcomes similar to those of patients without inflammatory rheumatic diseases. SLE was an independent prognostic predictor of both operative mortality and overall mortality and was probably associated with repeat revascularization, whereas ASp appeared to be associated with operative mortality. Because CAD is highly prevalent in patients with inflammatory rheumatic diseases, our findings may help surgeons and physicians recognize the inherent risks associated with SLE and ASp in patients undergoing CABG. The study was based on data from the NHIRD provided by the National Health Insurance administration, Ministry of Health and Welfare of Taiwan, and managed by the National Health Research Institutes of Taiwan. However, the interpretation and conclusions contained do not represent those of the National Health Insurance administration, Ministry of Health and Welfare of Taiwan, or the National Health Research Institutes of Taiwan. Appendix E1
Publisher Copyright:
© 2015 The American Association for Thoracic Surgery.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Objective Patients with inflammatory rheumatic diseases have an increased risk of developing coronary atherosclerosis. However, outcomes of surgical revascularization in these patients have been rarely studied. We aimed to determine whether, or which, inflammatory rheumatic diseases may pose effects on mortality and adverse cardiac outcomes after coronary artery bypass grafting. Methods By using the National Health Insurance Research Database of Taiwan, we identified 40,639 adult patients who underwent first-time coronary artery bypass grafting between 2000 and 2010. Among these patients, 101 had rheumatoid arthritis, 56 had systemic lupus erythematosus, and 73 had ankylosing spondylitis. The odds ratios (ORs) of operative mortality and hazard ratios (HRs) of overall mortality and adverse cardiac outcomes after coronary artery bypass grafting (ie, myocardial infarction and repeat revascularization) in relation to rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis were estimated. Results With adjustment for potential confounders including patient characteristics, hospital levels, and combined surgery, systemic lupus erythematosus was an independent predictor for operative mortality (adjusted OR, 2.63; 95% confidence interval [CI], 1.04-6.65; P =.04) and ankylosing spondylitis was marginally associated with operative mortality (adjusted OR, 2.41; 95% CI, 0.99-5.88; P =.054). Systemic lupus erythematosus was a significantly independent predictor for overall mortality during the follow-up period (adjusted HR, 2.23; 95% CI, 1.51-3.31; P <.0001) and might increase the risk of repeat revascularization (adjusted HR, 1.89; 95% CI, 0.97-3.68; P =.06). Neither rheumatoid arthritis nor ankylosing spondylitis was significantly associated with overall mortality and adverse cardiac outcomes. Conclusions Our study may help surgeons and physicians recognize the potential risks inherent to systemic lupus erythematosus and ankylosing spondylitis when conducting coronary artery bypass grafting and providing follow-up care.
AB - Objective Patients with inflammatory rheumatic diseases have an increased risk of developing coronary atherosclerosis. However, outcomes of surgical revascularization in these patients have been rarely studied. We aimed to determine whether, or which, inflammatory rheumatic diseases may pose effects on mortality and adverse cardiac outcomes after coronary artery bypass grafting. Methods By using the National Health Insurance Research Database of Taiwan, we identified 40,639 adult patients who underwent first-time coronary artery bypass grafting between 2000 and 2010. Among these patients, 101 had rheumatoid arthritis, 56 had systemic lupus erythematosus, and 73 had ankylosing spondylitis. The odds ratios (ORs) of operative mortality and hazard ratios (HRs) of overall mortality and adverse cardiac outcomes after coronary artery bypass grafting (ie, myocardial infarction and repeat revascularization) in relation to rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis were estimated. Results With adjustment for potential confounders including patient characteristics, hospital levels, and combined surgery, systemic lupus erythematosus was an independent predictor for operative mortality (adjusted OR, 2.63; 95% confidence interval [CI], 1.04-6.65; P =.04) and ankylosing spondylitis was marginally associated with operative mortality (adjusted OR, 2.41; 95% CI, 0.99-5.88; P =.054). Systemic lupus erythematosus was a significantly independent predictor for overall mortality during the follow-up period (adjusted HR, 2.23; 95% CI, 1.51-3.31; P <.0001) and might increase the risk of repeat revascularization (adjusted HR, 1.89; 95% CI, 0.97-3.68; P =.06). Neither rheumatoid arthritis nor ankylosing spondylitis was significantly associated with overall mortality and adverse cardiac outcomes. Conclusions Our study may help surgeons and physicians recognize the potential risks inherent to systemic lupus erythematosus and ankylosing spondylitis when conducting coronary artery bypass grafting and providing follow-up care.
UR - http://www.scopus.com/inward/record.url?scp=84926222798&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84926222798&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2014.11.038
DO - 10.1016/j.jtcvs.2014.11.038
M3 - Article
C2 - 25541410
AN - SCOPUS:84926222798
VL - 149
SP - 859-866.e2
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 3
ER -