Assessing the mortality burden after acute myocardial infarction in systemic lupus erythematosus: insights from the MINAP Registry

Objectives Acute myocardial infarction (AMI) is a leading cause of mortality globally. Although SLE is known to increase the risk of AMI, its impact on long-term outcomes following AMI in contemporary populations remains poorly defined. To determine whether individuals with SLE experience higher long-term mortality after AMI compared with those without SLE. Methods Adults hospitalised with AMI between January 2005 and March 2019 were identified from the Myocardial Ischaemia National Audit Project registry and linked with Hospital Episode Statistics and Office for National Statistics mortality records. Long-term all-cause and cardiovascular mortality were assessed up to 5 years post-AMI. Results Of 784,091 patients with AMI, 715 (0.1%) had a diagnosis of SLE. Patients with SLE were younger (median 63.9 vs. 70.3 years; P<0.001) and more often female (76% vs. 34%; P<0.001). Adjusted all-cause mortality was higher among those with SLE from 30 days (HR 1.62; 95% CI 1.23, 2.12; P=0.001) to 5 years (HR 1.84; 95% CI 1.63, 2.09; P<0.001). Adjusted cardiovascular mortality was similarly elevated at 30 days (HR 1.63; 95% CI 1.20–2.21; P=0.002) and 5 years (HR 1.75; 95% CI 1.46–2.10; P<0.001). Conclusions Individuals with SLE have a persistently higher risk of all-cause and cardiovascular mortality following AMI, despite being younger and having less traditional cardiovascular comorbidities. These findings highlight SLE as an independent determinant of adverse post-AMI outcomes and support aggressive, guideline-directed secondary prevention in this high-risk population.