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Clinical and vascular lesion characteristics of the patients with takayasu arteritis manifested firstly as acute myocardial infarction at onset.

ABSTRACT:

Objective

To explore clinical and vascular lesion characteristics of the patients with Takayasu arteritis (TA) manifested firstly as acute myocardial infarction (AMI) at onset and to improve the diagnostic rate of TA.

Methods

The clinical and angiographic data of six patients with TA manifested firstly as AMI at onset were retrospectively analyzed.

Results

Of six patients (16-25 years old), 83.33% (five cases) was female, three patients had a history of hypertension and three patients did not have any medical history. One patient had intermittent effort chest tightness. On admission patients all presented with chest pain, dyspnea, hypotension, cardiogenic shock, abnormal electrocardiogram, and elevated cardiac troponin I. The vessel involvement was left coronary main trunk 83.33%, left anterior descending artery 33.33% and left circumflex branch 16.67%, right coronary artery 66.67%, subclavian artery 83.33%, and renal artery 50%. Five patients received the emergency PCI. One patient died of heart failure. During follow-up 3 patients received again PCI treatment.

Conclusion

Clinical and vascular lesion characteristics of those patients were no discomfort before admission, and the suddenly typical manifestation of AMI. Severe stenosis or occlusion occurred in main coronary artery ostia and peripheral large artery. For the TA patients with hemodynamic instability the effectiveness of emergency PCI is positive.

SUBMITTER: Liu R

PROVIDER: S-EPMC9929309 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Clinical and vascular lesion characteristics of the patients with takayasu arteritis manifested firstly as acute myocardial infarction at onset.

Liu Ruifang R Xu Fangxing F Zhou Yujie Y Shi Dongmei D Liu Tongku T

Heliyon 20230120 2

<h4>Objective</h4>To explore clinical and vascular lesion characteristics of the patients with Takayasu arteritis (TA) manifested firstly as acute myocardial infarction (AMI) at onset and to improve the diagnostic rate of TA.<h4>Methods</h4>The clinical and angiographic data of six patients with TA manifested firstly as AMI at onset were retrospectively analyzed.<h4>Results</h4>Of six patients (16-25 years old), 83.33% (five cases) was female, three patients had a history of hypertension and thr ...[more]

PMID: 36816237

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Project description:BackgroundHypertension occurred in 30-80% of Takayasu arteritis (TAK) patients around the world and the occurrence of hypertension might worsen the disease prognosis. This study aimed to investigate the clinical characteristics and imaging phenotypes, as well as their associations with events free survival (EFS) in Chinese TAK patients with hypertension.MethodsThis current research was based on a prospectively ongoing observational cohort-the East China Takayasu Arteritis (ECTA) cohort, centered in Zhongshan Hospital, Fudan University. Totally, 204 TAK patients with hypertension were enrolled between January 2013 and December 2019. Clinical characteristics and imaging phenotypes of each case were evaluated and their associations with the EFS by the end of August 30, 2020, were analyzed.ResultsSevere hypertension accounted for 46.1% of the entire population. Three specific imaging phenotypes were identified: Cluster 1: involvement of the abdominal aorta and/or renal artery (27.5%); Cluster 2: involvement of the ascending aorta, thoracic aorta, the aortic arch, and/or its branches (18.6%); and Cluster 3: combined involvement of Cluster 1 and 2 (53.9%). Clinical characteristics, especially hypertensive severity, differed greatly among the three imaging clusters. In all, 187 patients were followed up for a median of 46 (9-102) months; 72 events were observed in 60 patients (1-3 per person). The overall blood pressure control rate was 50.8%, and the EFS was 67.9% by the end of the follow-up. Multivariate Cox regression indicated that controlled blood pressure (HR = 2.13, 95% CI 1.32-3.74), Cluster 1 (HR = 0.69, 95% CI 0.48-0.92) and Cluster 3 (HR = 0.72, 95% CI 0.43-0.94) imaging phenotype was associated with the EFS. Kaplan-Meier curves showed that patients with controlled blood pressure showed better EFS (p = 0.043). Furthermore, using cases with Cluster 1 imaging phenotype and controlled blood pressure as reference, better EFS was observed in patients with Cluster 2 phenotype and controlled blood pressure (HR = 2.21, 95%CI 1.47-4.32), while the case with Cluster 1 phenotype plus uncontrolled blood pressure (HR = 0.64, 95%CI 0.52-0.89) and those with Cluster 3 phenotype and uncontrolled blood pressure (HR = 0.83, 95%CI 0.76-0.92) suffered worse EFS.ConclusionBlood pressure control status and imaging phenotypes showed significant effects on the EFS for TAK patients with hypertension.

Dataset Information

Clinical and vascular lesion characteristics of the patients with takayasu arteritis manifested firstly as acute myocardial infarction at onset.

Objective

Methods

Results

Conclusion

Publications

Clinical and vascular lesion characteristics of the patients with takayasu arteritis manifested firstly as acute myocardial infarction at onset.

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