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Systemic lupus erythematosus and the risk of perioperative major adverse cardiovascular events

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Abstract

Systemic lupus erythematosus (SLE) is a significant risk factor for cardiovascular disease. The relationship between SLE and perioperative cardiovascular risks following non-cardiac surgery is uncertain. We investigated associations between a diagnosis of SLE and outcomes following major non-cardiac surgery in a large national database from the United States. Patients age ≥ 18 years requiring major non-cardiac surgery were identified from Healthcare Cost and Utilization Project’s National Inpatient Sample data from 2004 to 2014. Systemic lupus erythematosus and perioperative major adverse cardiovascular events (MACE; myocardial infarction, ischemic stroke or death) were defined by ICD-9 diagnosis codes. Perioperative MACE were reported for SLE patients stratified by age and sex. From 2004 to 2014, a total of 17,853,194 hospitalizations for major non-cardiac surgery met study inclusion criteria. SLE was identified in 70,578 (0.4%) hospitalizations. Overall, the frequency of perioperative MACE was higher in patients with vs. without SLE [2.4 vs. 2.0%, p < 0.001; adjusted OR (aOR) 1.25; 95% CI 1.18–1.31]. Perioperative MACE associated with SLE was largely driven by increased death (aOR 1.58 95% CI 1.40–1.77) and myocardial infarction (aOR 1.32; 95% CI 1.05–1.66) in younger patients with SLE. The increased risk of perioperative MACE associated with SLE in younger patients was attenuated with increasing age. A diagnosis of SLE is associated with increased risk of perioperative MACE, particularly among younger patients. Efforts to improve the perioperative management and outcomes of patients with SLE are needed.

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Acknowledgements

Nathaniel R. Smilowitz was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) under award T32HL098129. This work was supported, in part, by National Institutes of Health grants NIH R21AR071103 (JPB, RMC, JSB).

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Venous Thromboembolic Center, Marc and Ruti Bell Program in Vascular Biology, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA

    Nathaniel R. Smilowitz, Gregory Katz & Jeffrey S. Berger

  2. Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA

    Jill P. Buyon & Robert M. Clancy

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  1. Nathaniel R. Smilowitz
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  2. Gregory Katz
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  3. Jill P. Buyon
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  4. Robert M. Clancy
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  5. Jeffrey S. Berger
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Contributions

Concept and design: Smilowitz, Katz, Berger. Acquisition, analysis, or interpretation of data: Smilowitz, Katz, Buyon, Berger. Drafting of the manuscript: Smilowitz, Berger. Critical revision of the manuscript for important intellectual content: Smilowitz, Katz, Buyon, Clancy, Berger. Statistical analysis: Smilowitz, Berger. Supervision: Berger.

Corresponding author

Correspondence to Jeffrey S. Berger.

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The authors report no relationships that could be construed as a conflict of interest.

Ethical approval

This is an analysis of previously collected, publicly available, de-identified administrative data. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

Research involving animal participants

This article does not contain any studies with animals performed by any of the authors.

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Smilowitz, N.R., Katz, G., Buyon, J.P. et al. Systemic lupus erythematosus and the risk of perioperative major adverse cardiovascular events. J Thromb Thrombolysis 45, 13–17 (2018). https://doi.org/10.1007/s11239-017-1591-0

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  • DOI: https://doi.org/10.1007/s11239-017-1591-0

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