Highlights
- •GCA-related myocardial infarction (MI) is a rare event (2.4% of cases).
- •GCA-related MI are mainly type 2 MI rather than type 1 MI due to coronary artery disease.
- •GCA-unrelated MI are predominantly type 1 MI with atherothrombotic coronary artery disease.
Abstract
Background
Cardiovascular risk is increased in giant cell arteritis (GCA). We aimed to characterize
myocardial infarction (MI) in a GCA cohort, and to compare the GCA and non-GCA population
affected by MI.
Methods
In patients with a biopsy-proven diagnosis of GCA between 1 January 2001 and 31 December
2016 in Côte D'Or (France), we identified patients with MI by crossing data from the
territorial myocardial infarction registry (Observatoire des Infarctus de Côte d'Or) database. Five controls (non-GCA + MI) were paired with one case (GCA + MI) after
matching for age, sex, cardiovascular risk factors and prior cardiovascular disease.
MI were characterized as type 1 MI (T1MI), resulting from thrombus formation due to
atherothrombotic disease, or type 2 MI (T2MI), due to a myocardial supply/demand mismatch.
GCA-related MI was defined as MI occurring within 3 months of a GCA flare (before
or after).
Results
Among 251 biopsy-proven GCA patients, 13 MI cases were identified and paired with
65 controls. MI was GCA-related in 6/13 cases, accounting for 2.4% (6/251) of our
cohort. T2MI was more frequently GCA-related than GCA-unrelated (80% vs. 16.7%, p = 0.080),
and GCA diagnosis was the only identified triggering factor in 75% of GCA-related T2MI.
GCA-unrelated MI were more frequently T1MI and occurred in patients who had received
a higher cumulative dose of prednisone (p = 0.032). GCA was not associated with poorer one-year survival.
Conclusions
GCA-related MI are mainly T2MI probably caused by systemic inflammation rather than
coronaritis. GCA-unrelated MI are predominantly T1MI associated with atherothrombotic
coronary artery disease.
Keywords
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Article info
Publication history
Published online: February 17, 2021
Accepted:
February 4,
2021
Received in revised form:
February 2,
2021
Received:
November 24,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Myocardial infarction in giant cell arteritis: It is all a matter of balance.European Journal of Internal MedicineVol. 89
- PreviewPatients with giant cell arteritis (GCA) represent an extremely fragile population. This frailty arises from the combination of a chronic, highly inflammatory disease affecting patients invariably older than 50 years of age and long-term use of drugs with extensive metabolic side effects such as glucocorticoids [1, 2]. For this reason, management of GCA patients should not only aim at the symptomatic treatment of inflammatory manifestations and the prevention of short and long-term disease-related complications (i.e., sight loss, aortic aneurysms) [3, 4], but should always be weighted in order to minimize the potential treatment-related adverse events.
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