A model to predict cardiovascular events in patients with newly diagnosed wegener's granulomatosis and microscopic polyangiitis.
Suppiah R., Judge A., Batra R., Flossmann O., Harper L., Höglund P., Javaid MK., Jayne D., Mukhtyar C., Westman K., Davis JC., Hoffman GS., McCune WJ., Merkel PA., Clair EW., Seo P., Spiera R., Stone JH., Luqmani R.
OBJECTIVES:: To create a prognostic tool to quantify the 5 year cardiovascular (CV) risk in patients with newly diagnosed Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) without pre-morbid CV disease. METHODS:: We reviewed CV outcomes during the long term follow up of patients in the first 4 European Vasculitis Study Group (EUVAS) trials of WG and MPA. CV events were defined as: CV-death, stroke, myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention. Logistic regression was performed to create a model to predict the absolute risk of a CV event. The model was tested using the Wegener's Granulomatosis Etanercept Trial (WGET) cohort. RESULTS:: 74 / 535 (13.8%) of the patients with 5 years of follow up from the EUVAS trials had at least one CV event: 33/281 (11.7%) WG vs. 41/254 (16%) MPA. The independent determinants of CV outcomes were; older age [OR 1.45 (95%CI 1.11 - 1.90)]; diastolic hypertension [OR 1.97 (95%CI 0.98 - 3.95)], and positive PR3 ANCA status [OR 0.39 (95%CI 0.20 - 0.74)]. The model was validated using the WGET cohort (Area under ROC curve = 0.80). CONCLUSION:: Within 5 years of diagnosis of WG or MPA, 14% of patients will have a cardiovascular event. We have constructed and validated a tool to quantify the risk of a cardiovascular event based on age, diastolic hypertension and PR3 ANCA status in patients without prior CV disease. In patients with vasculitis, PR3 ANCA is associated with reduced cardiovascular risk compared to MPO ANCA or negative ANCA status.