Abstract 4363590: Coronary Vasculitis in Takayasu’s Arteritis

Abstract

Introduction: Takayasu’s arteritis (TAK) is a rare vasculitis that primarily affects the large arteries. Chronic inflammation within the vessel wall can lead to vascular remodeling with stenosing and aneurysmal damage. Although the patterns of aortic involvement of the disease are well-defined in TAK, less is known about the coronary involvement of the disease. Research Questions: What are the differences in TAK patients with and without coronary vasculitis? Aims: To compare the baseline and clinical features of TAK patients with and without coronary vasculitis. To seek correlations between extra-coronary vasculitic involvement and coronary vasculitic involvement of TAK Methods: The study cohort included a total of 76 patients with Takayasu’s Arteritis, including 63 without coronary vasculitis and 13 with coronary vasculitis. Coronary vasculitis was defined as the presence of 1 vasculitic lesion in a coronary artery. Baseline characteristics, diagnostic delay, clinical symptoms, medication use, comorbidities, and elevated acute phase reactants were compared between patients with and without coronary vasculitis. The presence of vasculitis on angiography in each arterial territory was collected. FDG-PET uptake intensity on PET imaging in each arterial territory was collected, with active vasculitis defined as an intensity score of 3. Active vasculitis by PET and vasculitic lesions on angiography were compared between those with and without coronary vasculitis. Results: Coronary arteritis was a presenting feature in 69% of TAK patients with coronary involvement. Interventions were performed in 62% of these patients, with post-operative complications in 63%. PCI was performed in 75% of patients with interventions and grafts in 63%. When[GP([1] comparing patients with and without coronary artery involvement, there were no significant differences in age, sex, disease duration, pattern of clinical symptoms, or distribution of arterial lesions outside of the coronary arteries. Among patients with known coronary involvement, active vasculitis in the ascending aorta by FDG-PET was 100% sensitive and 83% specific for ongoing active coronary arteritis. Conclusion: A substantial proportion of patients with TAK can develop coronary arteritis. These patients are clinically similar to other patients with TAK. Inflammation in the ascending aorta by FDG-PET is a sensitive but not specific marker for active coronary vasculitis.