Long-Term Outcomes After Percutaneous Coronary Intervention in Autoimmune Rheumatic Diseases

Background: Autoimmune rheumatic diseases (AIRDs) are associated with chronic inflammation, immune dysregulation, endothelial dysfunction, and accelerated atherosclerosis, contributing to excess cardiovascular morbidity and mortality. Prior studies have suggested worse outcomes following percutaneous coronary intervention (PCI) in patients with AIRDs; however, contemporary evidence remains heterogeneous. We performed an updated systematic review and meta-analysis evaluating long-term outcomes after PCI among patients with AIRDs. Methods: A systematic search of PubMed/MEDLINE, Cochrane Library, and Google Scholar was conducted from inception through May 2026 in accordance with PRISMA guidelines. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale and Cochrane Risk of Bias. Studies comparing PCI outcomes in patients with and without AIRDs were included. AIRDs comprised rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjögren syndrome, spondyloarthritis, psoriatic arthritis, mixed connective tissue disease, polymyositis, dermatomyositis, polymyalgia rheumatica, and systemic vasculitis. Primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE). Secondary outcomes included myocardial infarction (MI), repeat revascularization, in-hospital mortality, and readmission. As the MACE definitions varied across studies; study-reported composite cardiovascular endpoints were pooled as reported. Random-effects meta-analysis was performed using Review Manager 5.4.1. Results: Twelve studies comprising 7,104,017 patients undergoing PCI were included, including 40,667 patients with AIRDs and 6,963,350 without AIRD. Compared with patients without AIRDs, those with AIRDs had a higher risk of all-cause mortality (RR 1.36, 95% CI 1.09-1.70; p=0.007; I 2 =99%) and MACE outcomes (RR 1.15, 95% CI 1.05-1.27; p=0.002; I 2 =74%). No statistically significant differences were observed in recurrent MI (RR 1.33, 95% CI 0.98-1.79; p=0.07) or repeat revascularization (RR 1.31, 95% CI 1.00-1.71; p=0.05). In-hospital mortality was similar between groups (RR 1.21, 95% CI 0.69-2.14; p=0.50). However, AIRD patients had a significantly greater risk of readmission after PCI (RR 1.25, 95% CI 1.09-1.42; p=0.001). Conclusions: In this updated meta-analysis of more than 7.1 million patients undergoing PCI, AIRDs were associated with a higher risk of long-term mortality, MACE, and hospital readmission. These findings should be interpreted in the context of heterogeneous AIRD phenotypes, variable MACE definitions, and potential residual confounding. Future studies should determine whether disease activity, inflammatory burden, and immunomodulatory therapies modify cardiovascular risk after PCI.