Impact of coronary involvement on long-term outcomes in patients with Takayasu's arteritis

Abstract

Objectives: To identify the predictors of coronary involvement, and to determine the impact of coronary involvement on long-term outcomes in patients with Takayasu's arteritis (TAK).

Methods: This retrospective cohort study of TAK patients with coronary evaluation by angiography or computed tomography angiography was conducted in a tertiary center between 1990 and 2018. Risk factors for coronary involvement and predictors of overall survival, cardiovascular event-free survival, and relapse-free survival were investigated.

Results: The median follow-up was 4.3 years (IQR 2.8-7.1). Out of 130 consecutive TAK patients, 71 (54.6%) had coronary involvement. Multivariate analysis revealed that age (OR: 1.537 per 10-year increase, 95% CI: 1.176-2.009, p=0.002) and type V angiographic classification (OR: 3.449, 95% CI: 1.600-7.437, p=0.002) were independent predictors of coronary involvement. Coronary involvement (HR: 8.358, 95% CI: 1.887-37.033, p=0.015), left ventricular systolic dysfunction (HR: 3.889, 95% CI: 1.467-10.311, p=0.006), and aortic regurgitation (HR: 3.373, 95% CI: 1.209-9.408, p=0.020) were independent predictors of overall survival. Furthermore, coronary involvement and baseline active disease were independently associated with increased major cardiovascular events (HR: 10.333, 95% CI: 2.326-45.906, p=0.017; HR: 7.084, 95% CI: 1.677-29.914, p=0.008, respectively) and relapse (HR: 5.186, 95% CI: 2.381-11.295, p<0.001; HR: 5.694, 95% CI: 2.022-16.031, p=0.001, respectively). No immunosuppressive therapy was independently associated with increased cardiovascular events (HR: 2.560, 95% CI: 1.181-5.550, p=0.002).

Conclusions: Coronary involvement is an important predictor of poor long-term outcomes in patients with TAK. Increasing age and type V angiographic classification can help to identify TAK patients with coronary involvement.