Identification of Coronary Morphological Damage in Patients with Chronic Inflammatory Rheumatic Diseases

Objective: Patients with chronic inflammatory rheumatic diseases (CIRD) have a higher incidence of coronary artery disease (CAD) due to accelerated atherogenesis. This study aimed to assess the extent and location of CAD lesions in CIRD patients compared to non-CIRD patients. Methods: A retrospective study was conducted on CIRD patients (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis) who underwent coronary angiography at Hospital Fundación Jiménez Díaz (Madrid, Spain) between 2018-2022. For each CIRD patient, at least two frequency-matched controls were selected based on sex, age (+/- 2 years), diabetic status, and clinical indication for coronary angiography. The indications for coronary angiography in both groups were chronic coronary syndrome and acute coronary syndrome with or without ST elevation. Results: A total of 66 CIRD patients were included, with 42 (63.6%) women, and a median age of 66.6 years (range: 58.3–75.2). Compared to controls, CIRD patients had a higher number of affected coronary arteries (2.03 versus 1.56, p=0.03). The mid-anterior descending artery and the right posterior descending artery were more frequently involved in CIRD patients than in controls (odds ratio [OR] 2.45 and 3.53, respectively, p≤0.02 for both comparisons). The frequency of coronary calcification was higher in CIRD patients, though the difference did not reach statistical significance (5 of 66 in CIRD patients versus 3 of 140 in non-CIRD controls, OR 3.74, p=0.06). Revascularization was more commonly performed in patients with CIRD (50 of 66 versus 85 of 140 in those without CIRD (OR: 2.02 [95% CI: 1.01-4.18]; p=0.03). Conclusion: Patients with CIRD exhibit more extensive CAD, with a higher propensity for involvement of the mid-anterior descending and right posterior descending arteries compared to patients without CIRD.