Journal
CHEST
Volume 146, Issue 6, Pages 1494-1504Publisher
ELSEVIER
DOI: 10.1378/chest.13-3014
Keywords
-
Categories
Funding
- Gilead Sciences, Inc
- United Therapeutics Corp
- Pfizer, Inc
- Actelion Pharmaceuticals Ltd
- Advisory Board for Gilead Sciences, Inc
- pharmaceutical companies
- BioStatistical CRO for the REVEAL Registr
- Actelion/CoTherix
- Medtronic, Inc
- Enteligence-Actelion career development research
Ask authors/readers for more resources
BACKGROUND: Patients with pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc-APAH) experience higher mortality rates than patients with idiopathic disease and those with other connective tissue diseases (CTD-APAH). We sought to identify unique predictors of mortality associated with SSc-APAH in the CTD-APAH population. METHODS: The Registry to Evaluate Early and Long-Term PAH Management (REVEAL Registry) is a multicenter, prospective US-based registry of patients with previously and newly diagnosed (enrollment within 90 days of diagnostic right-sided heart catheterization) PAH. Cox regression models evaluated all previously identified candidate predictors of mortality in the overall REVEAL Registry population to identify significant predictors of mortality in the SSc-APAH (n = 500) vs non-SSc-CTD-APAH (n = 304) populations. RESULTS: Three-year survival rates in the previously diagnosed and newly diagnosed SScAPAH group were 61.4% +/- 2.7% and 51.2% +/- 4.0%, respectively, compared with 80.9% +/- 2.7% and 76.4% +/- 4.6%, respectively, in the non-SSc-CTD-APAH group (P<.001). In multivariate analyses, men aged. 60 years, systolic BP (SBP) <= 110 mm Hg, 6-min walk distance (6MWD), 165 m, mean right atrial pressure (mRAP)>20 mm Hg within 1 year, and pulmonary vascular resistance (PVR)>32 Wood units remained unique predictors of mortality in the SSc-APAH group; 6MWD >= 440 m was protective in the non-SSc-CTD-APAH group, but not the SSc-APAH group. CONCLUSIONS: Patients with SSc-APAH have higher mortality rates than patients with non-SSc- CTD-APAH. Identifying patients with SSc-APAH who are at a particularly high risk of death, including elderly men and patients with low baseline SBP or 6MWD, or markedly elevated mRAP or PVR, will enable physicians to identify patients who may benefit from closer monitoring and more aggressive treatment.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available