Prevalence and Characteristics of Coronary Arteritis within a Prospective Observational Cohort of Patients with Takayasu's Arteritis

Abstract

ABSTRACT Introduction: Due to the rarity of the condition, optimal assessment and therapeutic strategies to manage coronary arteritis in Takayasu's arteritis (TAK) have not been well defined. Methods: Cases of coronary arteritis were identified within an ongoing single-center prospective observational cohort study in TAK. Patients underwent standardized clinical, imaging, and laboratory assessment per protocol with centralized review of data. Imaging assessment included non-invasive angiography of the aorta and branch vessels, cardiac computed tomographic angiography, cardiovascular magnetic resonance imaging, and positron emission tomography (PET). Cardiac involvement was defined based on demonstration of at least one vasculitic lesion within a coronary artery by an appropriate imaging study. Results: The prevalence of coronary arteritis was 13 (9%) out of 137 patients with TAK. Patients with and without coronary arteritis were similar in terms of demographics, angiographic pattern of disease, and non-cardiac clinical symptoms. Vasculitic lesions typically were stenosing and involved the proximal coronary arteries. Active vasculitis by PET in the ascending aorta was associated with active coronary arteritis (sensitivity 100%, specificity 67%). Favorable clinical outcomes were generally achievable but often required medical therapy and vascular intervention. Anti-cytokine medical therapies were likely more effective than cytotoxic therapies. Fifty percent of patients had complications from vascular grafts or stents, respectively, often prompting additional vascular procedures. Discussion: Coronary arteritis is an uncommon complication in TAK. Multimodal imaging can be useful to diagnose, monitor, and manage coronary arteritis. While medical therapy is preferred, vascular intervention may be necessary, and complications from attempts at vascular reperfusion are common.