Impact of Antiphospholipid Syndrome and/or Systemic Lupus Erythematosus on the Long-term Adverse Cardiovascular Outcomes in Patients After Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis.
Impact of Antiphospholipid Syndrome and/or Systemic Lupus Erythematosus on the Long-term Adverse Cardiovascular Outcomes in Patients After Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis.
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DOI：
10.1097/md.0000000000003200
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发表时间：
2016-03
期刊：
影响因子：
1.6
通讯作者：
Chen MH
中科院分区：
文献类型：
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作者：
Bundhun PK;Boodhoo KD;Long MY;Chen MH
抗磷脂综合征 (APS) 和系统性红斑狼疮 (SLE) 是两种罕见的自身免疫性疾病，通常影响女性。之前的几项研究表明 APS 是从 SLE 演变而来的。继发性 APS 常与 SLE 共存。这两种疾病的一个共同特征是抗磷脂抗体，大多数 APS 患者和约 30% 至 40% 的 SLE 患者中都存在抗磷脂抗体，其中约 10% 会出现 APS。这些患者的主要原因是动脉粥样硬化加速导致的心血管疾病，与一般人群相比，动脉粥样硬化的进展往往更快。然而，APS 和/或 SLE 对接受经皮冠状动脉介入治疗 (PCI) 患者心血管结局的影响存在争议。因此，为了解决这个问题，我们的目标是比较患有 APS 和/或 SLE 的患者以及没有这些疾病的患者 PCI 后的长期（≥1 年）不良心血管结局。检索了 Medline 和 EMBASE 数据库，以比较 PCI 术后 SLE 和非 SLE、APS 和非 APS、或 SLE + APS 和非 SLE + 非 APS 之间的长期不良心血管结局。我们计算了这些分类变量的奇数比 (OR) 和 95% 置信区间 (CI)，并使用 RevMan 5.3 进行汇总分析。本次荟萃分析纳入了 7 项研究，共计 253,436 名患者（实验组 568 名患者，对照组 252,868 名患者）。在≥1年的随访期间，实验组的死亡率和心肌梗死（MI）显着较高（分别为OR 2.02，95% CI 1.63–2.49，P < 0.00001和OR 1.59，95% CI 1.23–2.05，P = 0.0004）。 SLE/APS 组的主要不良心脏事件和重复血运重建也显着较高（分别为 OR 2.40、95% CI 1.42–4.03、P = 0.001 和 OR 2.59、95% CI 1.26–5.31、P = 0.01）。抗磷脂综合征和 SLE 与 PCI 后显着较高的长期（≥1 年）不良心血管结局相关。然而，由于患者数量和所做的研究有限，并且由于在几个亚组中观察到的异质性比例较大，该分析可能不会产生强有力的结果。
Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are 2 rare autoimmune disorders which commonly affect women. Several previous studies showed APS to have been evolved from SLE. Secondary APS often coexists with SLE. One common feature relating these 2 diseases are the antiphospholipid antibodies, which are found in most of the patients with APS and in approximately 30% to 40% of patients with SLE, among which, about 10% develop APS. The leading cause of death in these patients is from cardiovascular disease due to accelerated atherosclerosis, which often progresses more rapidly, compared with the general population. However, the impact of APS and/or SLE on the cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) is controversial. Therefore, to solve this issue, we aim to compare the long-term (≥1 year) adverse cardiovascular outcomes after PCI, in patients with APS and/or SLE, and those without these disorders. Medline and EMBASE databases were searched for studies comparing the long-term adverse cardiovascular outcomes between SLE and non-SLE, APS and non-APS, or SLE + APS and non-SLE + non-APS after PCI. We calculated odd ratios (OR) and 95% confidence intervals (CIs) for these categorical variables, and the pooled analyses were performed with RevMan 5.3. Seven studies consisting of a total of 253,436 patients (568 patients in the experimental group and 252,868 patients in the control group) were included in this meta-analysis. During a follow-up period of ≥1 year, mortality and myocardial Infarction (MI) were significantly higher in the experimental group (OR 2.02, 95% CI 1.63–2.49, P < 0.00001 and OR 1.59, 95% CI 1.23–2.05, P = 0.0004, respectively). Major adverse cardiac events and repeated revascularization were also significantly higher in the SLE/APS group (OR 2.40, 95% CI 1.42–4.03, P = 0.001 and OR 2.59, 95% CI 1.26–5.31, P = 0.01, respectively). Antiphospholipid syndrome and SLE are associated with significantly higher long-term (≥1 year) adverse cardiovascular outcomes after PCI. However, because of the limited number of patients and researches done, and due to a larger percentage of heterogeneity observed among several subgroups, this analysis may not generate a powerful result.