Characteristics and outcomes of coronary artery involvement in polyarteritis nodosa

Abstract Background Coronary artery involvement is a severe but uncommon manifestation of polyarteritis nodosa (PAN), so clinicians have little knowledge of it. Our aim is to investigate the clinical characteristics, risk factors and outcomes of patients with PAN complicated with coronary artery lesions. Methods Data from 145 patients with PAN who were admitted to Peking Union Medical College Hospital from January 2000 to September 2019 were retrospectively collected. Results Nineteen (13.1%) patients had coronary artery lesions due to PAN. The age at the onset of PAN was 32.3±11.8 years. The two groups exhibited no significant differences in common risk factors for coronary arterial atherosclerosis. Affected branches of the coronary arteries were the left anterior descending branch (LAD) (15 patients), right coronary artery (RCA) (14 patients) and left circumflex branch (LCX) (9 patients). Eleven of these nineteen patients exhibited multivessel lesions. Multivariate logistic regression analysis showed that celiac artery involvement (OR 3.722, 95% CI 1.115-12.427, p=0.033) and new-onset hypertension (OR 6.668, 95% CI 1.936-22.961, p=0.003) were risk factors for coronary artery involvement in PAN patients. Stent placement was performed for 2 patients, and in-stent restenosis occurred in one patient a year later. Conclusions PAN with coronary artery involvement exhibits more combined involvement of arteries of other organs and more severe diseases. PAN should be considered when treating young adults with an unknown origin of coronary artery lesions. In addition to systemic immunosuppressive treatment, other measures including antiplatelet and anticoagulation therapy, should be initiated; however, determining the optimal time to perform the procedures such as intervention or surgical operations, is still challenging.