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Myocardial infarction during giant cell arteritis: A cohort study

Published:February 17, 2021DOI:https://doi.org/10.1016/j.ejim.2021.02.001

      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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      References

        • Salvarani C.
        • Cantini F.
        • Boiardi L.
        • Hunder G.G.
        Polymyalgia rheumatica and giant-cell arteritis.
        N Engl J Med. 2002; 347: 261-271
        • Hunder G.G.
        • Bloch D.A.
        • Michel B.A.
        • Stevens M.B.
        • Arend W.P.
        • Calabrese L.H.
        • et al.
        The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis.
        Arthritis Rheum. 1990; 33: 1122-1128
        • Richier Q.
        • Deltombe T.
        • Foucher A.
        • Roussin C.
        • Raffray L.
        Giant cell arteritis incidence in La Reunion island, a particularly cosmopolite region of south hemisphere.
        Eur J Intern Med. 2020; 74: 119-120
        • Weyand C.M.
        • Goronzy J.J.
        Medium- and large-vessel vasculitis.
        N Engl J Med. 2003; 349: 160-169
        • de Boysson H.
        • Liozon E.
        • Larivière D.
        • Samson M.
        • Parienti J.
        • Boutemy J.
        • et al.
        Giant cell arteritis-related stroke: a retrospective multicenter case-control study.
        J Rheumatol. 2017; 44: 297-303
        • Samson M.
        • Jacquin A.
        • Audia S.
        • Daubail B.
        • Devilliers H.
        • Petrella T.
        • et al.
        Stroke associated with giant cell arteritis: a population-based study.
        J Neurol, Neurosurg Psychiatry. 2015; 86: 216-221
        • Caudrelier L.
        • Moulis G.
        • Lapeyre-Mestre M.
        • Sailler L.
        • Pugnet G.
        Validation of giant cell arteritis diagnosis code in the French hospital electronic database.
        Eur J Intern Med. 2019; 60: e16-ee7
        • Weyand C.M.
        • Goronzy J.J.
        Immune mechanisms in medium and large-vessel vasculitis.
        Nat Rev Rheumatol. 2013; 9: 731-740
        • Watanabe R.
        • Zhang H.
        • Berry G.
        • Goronzy J.J.
        • Weyand C.M.
        Immune checkpoint dysfunction in large and medium vessel vasculitis.
        Am J Physiol Heart Circ Physiol. 2017; 312: H1052-H10H9
        • Proven A.
        • Gabriel S.E.
        • Orces C.
        • O'Fallon W.M.
        • Hunder G.G.
        Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes.
        Arthr Rheum. 2003; 49: 703-708
        • Samson M.
        • Devilliers H.
        • Ly K.H.
        • Maurier F.
        • Bienvenu B.
        • Terrier B.
        • et al.
        Tocilizumab as an add-on therapy to glucocorticoids during the first 3months of treatment of Giant cell arteritis: A prospective study.
        Eur J Intern Med. 2018;
        • Samson M.
        • Espígol-Frigolé G.
        • Terrades-García N.
        • Prieto-González S.
        • Corbera-Bellalta M.
        • Alba-Rovira R.
        • et al.
        Biological treatments in giant cell arteritis & Takayasu arteritis.
        Eur J Intern Med. 2018; 50: 12-19
        • Mahr A.D.
        • Jover J.A.
        • Spiera R.F.
        • Hernandez-Garcia C.
        • Fernandez-Gutierrez B.
        • Lavalley M.P.
        • et al.
        Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis.
        Arthr Rheum. 2007; 56: 2789-2797
        • Stone J.H.
        • Tuckwell K.
        • Dimonaco S.
        • Klearman M.
        • Aringer M.
        • Blockmans D.
        • et al.
        Trial of Tocilizumab in Giant-Cell Arteritis.
        N Engl J Med. 2017; 377: 317-328
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • Chaitman B.R.
        • Bax J.J.
        • Morrow D.A.
        • et al.
        Fourth universal definition of myocardial infarction.
        Circulation. 2018; 138 (2018): e618-ee51
        • Saaby L.
        • Poulsen T.S.
        • Hosbond S.
        • Larsen T.B.
        • Pyndt Diederichsen A.C.
        • Hallas J.
        • et al.
        Classification of myocardial infarction: frequency and features of type 2 myocardial infarction.
        Am J Med. 2013; 126: 789-797
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • Simoons M.L.
        • Chaitman B.R.
        • White H.D.
        • et al.
        Third universal definition of myocardial infarction.
        Circulation. 2012; 126: 2020-2035
        • Landes U.
        • Bental T.
        • Orvin K.
        • Vaknin-Assa H.
        • Rechavia E.
        • Iakobishvili Z.
        • et al.
        Type 2 myocardial infarction: A descriptive analysis and comparison with type 1 myocardial infarction.
        J Cardiol. 2016; 67: 51-56
        • Putot A.
        • Jeanmichel M.
        • Chague F.
        • Manckoundia P.
        • Cottin Y.
        • Zeller M.
        Type 2 myocardial infarction: a geriatric population-based model of pathogenesis.
        Aging Dis. 2020; 11: 108-117
        • Landesberg G.
        • Beattie W.S.
        • Mosseri M.
        • Jaffe A.S.
        • Alpert J.S.
        Perioperative myocardial infarction.
        Circulation. 2009; 119: 2936-2944
        • Gupta S.
        • Vaidya S.R.
        • Arora S.
        • Bahekar A.
        • Devarapally S.R.
        Type 2 versus type 1 myocardial infarction: a comparison of clinical characteristics and outcomes with a meta-analysis of observational studies.
        Cardiovasc Diagn Ther. 2017; 7: 348-358
        • Kermani T.A.
        • Warrington K.J.
        Prognosis and monitoring of giant cell arteritis and associated complications.
        Expert Rev Clin Immunol. 2018; 14: 379-388
        • Robson J.C.
        • Kiran A.
        • Maskell J.
        • Hutchings A.
        • Arden N.
        • Dasgupta B.
        • et al.
        The relative risk of aortic aneurysm in patients with giant cell arteritis compared with the general population of the UK.
        Ann Rheum Dis. 2015; 74: 129-135
        • Schönau V.
        • Vogel K.
        • Englbrecht M.
        • Wacker J.
        • Schmidt D.
        • Manger B.
        • et al.
        The value of 18F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study.
        Ann Rheum Dis. 2018; 77: 70-77
        • Prieto-Gonzalez S.
        • Depetris M.
        • Garcia-Martinez A.
        • Espigol-Frigole G.
        • Tavera-Bahillo I.
        • Corbera-Bellata M.
        • et al.
        Positron emission tomography assessment of large vessel inflammation in patients with newly diagnosed, biopsy-proven giant cell arteritis: a prospective, case-control study.
        Ann Rheum Dis. 2014; 73: 1388-1392
        • Kermani T.A.
        • Warrington K.J.
        • Crowson C.S.
        • Ytterberg S.R.
        • Hunder G.G.
        • Gabriel S.E.
        • et al.
        Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis.
        Ann Rheum Dis. 2013; 72: 1989-1994
        • Blockmans D.
        • de Ceuninck L.
        • Vanderschueren S.
        • Knockaert D.
        • Mortelmans L.
        • Bobbaers H.
        Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients.
        Arthr Rheum. 2006; 55: 131-137
        • Ghinoi A.
        • Pipitone N.
        • Nicolini A.
        • Boiardi L.
        • Silingardi M.
        • Germano G.
        • et al.
        Large-vessel involvement in recent-onset giant cell arteritis: a case-control colour-Doppler sonography study.
        Rheumatology (Oxford). 2012; 51: 730-734
        • Le Page L.
        • Duhaut P.
        • Seydoux D.
        • Bosshard S.
        • Ecochard R.
        • Abbas F.
        • et al.
        Incidence of cardiovascular events in giant cell arteritis: preliminary results of a prospective double cohort study (GRACG).
        Rev Med Interne. 2006; 27: 98-105
        • Ray J.G.
        • Mamdani M.M.
        • Geerts WH.
        Giant cell arteritis and cardiovascular disease in older adults.
        Heart. 2005; 91: 324-328
        • Tomasson G.
        • Peloquin C.
        • Mohammad A.
        • Love T.J.
        • Zhang Y.
        • Choi H.K.
        • et al.
        Risk for cardiovascular disease early and late after a diagnosis of giant-cell arteritis: a cohort study.
        Ann Intern Med. 2014; 160: 73-80
        • Pariente A.
        • Guedon A.
        • Alamowitch S.
        • Thietart S.
        • Carrat F.
        • Delorme S.
        • et al.
        Ischemic stroke in giant-cell arteritis: French retrospective study.
        J Autoimmun. 2019; 99: 48-51
        • Gonzalez-Gay M.A.
        • Vazquez-Rodriguez T.R.
        • Gomez-Acebo I.
        • Pego-Reigosa R.
        • Lopez-Diaz M.J.
        • Vazquez-Trinanes M.C.
        • et al.
        Strokes at time of disease diagnosis in a series of 287 patients with biopsy-proven giant cell arteritis.
        Medicine (Baltimore). 2009; 88: 227-235
        • Amiri N.
        • De Vera M.
        • Choi H.K.
        • Sayre E.C.
        • Avina-Zubieta J.A.
        Increased risk of cardiovascular disease in giant cell arteritis: a general population-based study.
        Rheumatology (Oxford). 2016; 55: 33-40
        • Li L.
        • Neogi T.
        • Jick S.
        Giant cell arteritis and vascular disease-risk factors and outcomes: a cohort study using UK Clinical Practice Research Datalink.
        Rheumatology (Oxford). 2017; 56: 753-762
        • Lin L.
        • Wang S.
        • Shun C.
        Myocardial infarction due to giant cell arteritis: a case report and literature review.
        Kaohsiung J Med Sci. 2007; 23: 195-198
        • Salvarani C.
        • Cantini F.
        • Hunder G.G.
        Polymyalgia rheumatica and giant-cell arteritis.
        Lancet. 2008; 372: 234-245
        • Zeller M.
        • Steg P.G.
        • Ravisy J.
        • Lorgis L.
        • Laurent Y.
        • Sicard P.
        • et al.
        Relation between body mass index, waist circumference, and death after acute myocardial infarction.
        Circulation. 2008; 118: 482-490
        • Granger C.B.
        • Goldberg R.J.
        • Dabbous O.
        • Pieper K.S.
        • Eagle K.A.
        • Cannon C.P.
        • et al.
        Predictors of hospital mortality in the global registry of acute coronary events.
        Arch Intern Med. 2003; 163: 2345-2353
        • Cerqueira Junior A.
        • Pereira L.
        • Souza T.M.B.
        • Correia V.C.A.
        • Alexandre F.K.B.
        • Sodre G.S.
        • et al.
        Prognostic Accuracy of the GRACE Score in Octogenarians and Nonagenarians with Acute Coronary Syndromes.
        Arq Bras Cardiol. 2018; 110: 24-29
        • Pepine C.J.
        • Ferdinand K.C.
        • Shaw L.J.
        • Light-McGroary K.A.
        • Shah R.U.
        • Gulati M.
        • et al.
        Emergence of nonobstructive coronary artery disease: a woman's problem and need for change in definition on angiography.
        J Am Coll Cardiol. 2015; 66: 1918-1933
        • Ammann P.
        • Fehr T.
        • Minder E.I.
        • Gunter C.
        • Bertel O.
        Elevation of troponin I in sepsis and septic shock.
        Intensive Care Med. 2001; 27: 965-969
        • Putot A.
        • Jeanmichel M.
        • Chague F.
        • Avondo A.
        • Ray P.
        • Manckoundia P.
        • et al.
        Type 1 or Type 2 myocardial infarction in patients with a history of coronary artery disease: data from the emergency department.
        J Clin Med. 2019; 8
        • Avina-Zubieta J.A.
        • Abrahamowicz M.
        • De Vera M.A.
        • Choi H.K.
        • Sayre E.C.
        • Rahman M.M.
        • et al.
        Immediate and past cumulative effects of oral glucocorticoids on the risk of acute myocardial infarction in rheumatoid arthritis: a population-based study.
        Rheumatology (Oxford). 2013; 52: 68-75
        • Wilson J.C.
        • Sarsour K.
        • Collinson N.
        • Tuckwell K.
        • Musselman D.
        • Klearman M.
        • et al.
        Serious adverse effects associated with glucocorticoid therapy in patients with giant cell arteritis (GCA): a nested case-control analysis.
        Semin Arthr Rheum. 2017; 46: 819-827
        • Wei L.
        • MacDonald T.
        • Walker B.
        Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease.
        Ann Intern Med. 2004; 141: 764-770
        • Borchers A.T.
        • Gershwin M.E.
        Giant cell arteritis: a review of classification, pathophysiology, geoepidemiology and treatment.
        Autoimmun Rev. 2012; 11: A544-A554
        • Muratore F.
        • Kermani T.A.
        • Crowson C.S.
        • Green A.B.
        • Salvarani C.
        • Matteson E.L.
        • et al.
        Large-vessel giant cell arteritis: a cohort study.
        Rheumatology (Oxford). 2015; 54: 463-470

      Linked Article

      • Myocardial infarction in giant cell arteritis: It is all a matter of balance.
        European Journal of Internal MedicineVol. 89
        • Preview
          Patients 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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