POS0252\u2005IMPACT OF ANCA-ASSOCIATED VASCULITIS ON CLINICAL OUTCOMES AND RESOURCE UTILIZATION IN ELECTIVE PCI

Abstract

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides (AV) can increase risk of atherosclerosis. 1 Patients with autoimmune disease have increased rates of coronary events that are not fully explained by classic risk factors. 2 A prior study has shown that autoimmune vasculitides –including polyarteritis nodosa, hypersensitivity granulomatosis with polyangiitis, giant cell arteritis, thrombotic angiitis, Takayasu arteritis, Goodpasture syndrome, and Kawasaki disease –are associated with increased cost of care and increased 30-day readmission after percutaneous coronary intervention (PCI). 3 It is important to distinguish the cardiovascular outcomes of small–vessel ANCA-associated vasculitides from the other vasculitides included in this prior study because coronary arteritis is typically a complication of medium to large vessel vasculitis.To investigate the impact of comorbid ANCA-associated small vessel vasculitis (AV) on outcomes of PCI in a nationally representative cohort.Patients undergoing PCI in the 2016-2018 National Inpatient Sample were selected and those with ANCA-associated vasculitis were identified using the ICD-10 classification system. The NIS is an all-payer, survey-weighted, inpatient database estimating 37 million annual U.S. hospitalizations managed by the Healthcare Cost and Utilization Project (HCUP). Primary study outcomes were prevalence of comorbid vasculitis, mortality, complications, and cost of care.Of 1,351,670 patients undergoing PCI were identified, 410 (0.03%) had diagnosis of ANCA-vasculitis. AV patients were similar to non-AV patients in distribution of gender, race, and median household income. AV patients were older (70.9 vs 65.2 years, P<0.001) and more likely to utilize Medicare (78% vs 53%, P<0.005). AV patients were more likely to present with non-ST segment myocardial infarction (NSTEMI) (57.3% vs 41.5%, P<0.005) and less likely to present with ST-elevation myocardial infarction (NSTEMI) (18.3% vs 31.3%, P<0.05). AV patients had similar adjusted mortality (6.1% vs 2.6%, aOR: 2.1, P=0.8), cost of care ($32,985 vs $25,767, β = 0.02, P=0.7), and length of hospitalization (6.0 vs 3.9, IRR: 1.2, P=0.13).The presence of ANCA-associated vasculitis did not appear to negatively impact inpatient clinical outcomes or utilization of care among patients undergoing PCI in the United States. Cost of care was not increased, in contrast to an increase cost of care when small, medium, and large vasculitides are grouped together. The greater proportion of NSTEMI patients among those with AAV corresponds with a growing body of literature implicating inflammatory processes in the pathogenesis of certain forms of myocardial infarction meriting further investigation.[1]Misra DP, Shenoy SN. Cardiac involvement in primary systemic vasculitis and potential drug therapies to reduce cardiovascular risk. Rheumatol Int. 2017;37(1):151-167. doi:10.1007/s00296-016-3435-1.[2]Amaya-Amaya J, Sarmiento-Monroy JC, Rojas-Villarraga A. Cardiovascular Involvement in Autoimmune Diseases. El Rosario University Press; 2013. Accessed February 1, 2021. https://www.ncbi.nlm.nih.gov/books/NBK459468/.[3]Bailey KL, Mantha A, Sanaiha Y, Mathias L, Benharash P, Ebrahimi R. Short-Term Outcomes After Percutaneous Coronary Intervention in Patients With Autoimmune Vasculitides. J Am Coll Cardiol. 2019;74(1):159-160. doi:10.1016/j.jacc.2019.04.051.None declared