Surgery poses cardiac risk to lupus women

Women with systemic lupus erythematosus (SLE) are at significantly increased risk for short-term perioperative adverse cardiovascular (CV) events, find researchers.

These findings highlight a need for greater scrutiny during perioperative evaluation and management of women with SLE, report Ali Yazdanyar (The Reading Hospital and Medical Center, Philadelphia, USA) and co-authors.

The cross-sectional analysis of pooled hospital discharge data from 1992 to 2002 of the National Inpatient Sample showed that all-cause mortality was significantly greater among women with SLE who had a low or high cardiac risk principal procedure (odds ratios=1.54 and 2.52, respectively) compared with those without SLE.

Principal procedures were categorized as low-, intermediate-, or high-risk for cardiac events based on American College of Cardiology/American Heart Association guidelines. Endoscopic, ophthalmologic, and breast procedures were categorized as low-risk, while orthopedic and intra-abdominal procedures were intermediate-risk.

High-risk procedures included peripheral vascular surgery with the exception of carotid endarterectomy and noncardiac procedures within the cardiothoracic cavity.

All-cause mortality did not differ significantly between women with and without SLE had intermediate-risk procedures.

But women with SLE who underwent a low-risk surgical procedure were a significant 40% more likely to experience a composite CV event (acute myocardial infarction [MI], non-ST elevation MI, congestive heart failure with pulmonary edema, and/or cerebrovascular accident) than those without SLE.

The study included 5,267,588 elective hospitalizations with a noncardiac principal procedure among women with and without SLE, of whom 3,640,994 were categorized as low-, 1,513,596 as intermediate-, and 112,997 as high-risk procedures.

"The perioperative setting represents a time of heightened risk for morbidity and mortality, especially in individuals at increased risk of CVD," write Yazdanyar et al in Arthritis Care & Research.

They conclude: "The results of our study, which revealed an increased risk of adverse perioperative events in women with SLE, indicate a need for greater scrutiny in perioperative clinical care in addition to further investigation as to the non-CV causes of increased perioperative mortality observed in women with SLE."

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