SLE Higher Risk of Postoperative Cardiac Events Save

ACR Open Rheumatology reports that systemic lupus erythematosus (SLE) patients have a higher risk of postoperative major adverse cardiac events (MACE) that can be identified by common cardiac risk measures.

Researchers used national claims-based data (Optum Clinformatics 2007 - 2020) to examine MACE events in SLE patients undergoing noncardiac surgeries and compared findings to non-lupus controls, one with diabetes mellitus (DM) and one without DM. Patients were also characterized by their Charlson comorbidity score and the Revised Cardiac Risk Index (RCRI) score. The RCRI score counts 6 conditions present within 1 year of surgery: ischemic heart disease, congestive heart failure, cerebrovascular disease, chronic kidney disease, insulin-dependent DM.

The cohorts included 4750 SLE patients and 496,381 DM controls, and 1,484,986 non-DM controls.

The risk of MACE was significantly higher in SLE patients (compared to non-DM controls) (OR - 1.51; 1.09-2.08), which decreased to normal after adjustment for RCRI score (OR: 0.97).

Lupus patients had an equivalent risk of MACE if compared to DM controls (0.82 vs 1.04, P = 0.16).

Importantly, high-risk SLE patients (RCRI score of ≥3) were less likely to receive preoperative cardiac testing than non-DM controls (42.7% vs 35.1%, P < 0.05).

These data inform actual risks for SLE patients and suggest a need for more cardiac testing prior to undergoing surgery.