Is there a premature mortality burden after acute myocardial infarction in people with systemic lupus erythematosus? insights from the MINAP registry

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Abstract Background Acute myocardial infarction (AMI) is the leading cause of mortality within individuals with Systemic Lupus Erythematosus (SLE). SLE increases the risk of AMI but how SLE affects the long-term outcomes post AMI in a contemporary cohort of patients is poorly understood. Aims In this study we aimed to assess whether individuals with SLE have a higher premature mortality risk after AMI compared to individuals without SLE. Methods We analysed adults hospitalised between January 2005 and March 2019, with AMI from the Myocardial Ischaemia National Audit Project registry, linked with Office for National Statistics mortality reporting. We assessed long term all cause and cardiovascular mortality up to 5 years of follow up. Results Of the 784,091 patients with AMI, 715 had a current diagnosis of SLE (0.1%). Individuals with SLE were younger (median 63.9 vs 70.3 years, P<0.001) and more likely to be female (76% vs 34%, P<0.001). Individuals with SLE had a higher adjusted all-cause mortality at 30-day (1.36, 95% CI; 1.02,1.81, P=0.037) to 5 year follow up (1.68, 95% CI; 1.48, 1.92, P<0.001). Individuals with SLE also had a higher adjusted cardiovascular mortality at 30-day (1.44, 95% CI; 1.04-1.99, P=0.028) to 5 year follow up (1.62, 95% CI; 1.34-1.96, P<0.001). Conclusion There is a higher risk of premature mortality after AMI within individuals with SLE compared with those without. This further establishes individuals with SLE as higher risk cardiovascular patients and highlights the need for strict adherence to guideline directed secondary prevention.

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