Ischemic complications in Takayasu's arteritis: A meta-analysis

Objectives: Takayasu's arteritis (TAK) is a rare vasculitis affecting the large blood vessels with significant morbidity and mortality from ischemic complications. The objective of this meta-analysis is to determine the proportion of TAK patients with severe ischemic complications. Methods: We performed a literature search using MEDLINE, EMBASE, and the Cochrane library from database inception to March 2016. We included articles that reported at least one severe ischemic complication. A random effects model with inverse-variance weighting was performed to estimate the pooled proportion of TAK subjects with ischemic complications. Results: In all, 35 studies met inclusion criteria, representing 3262 TAK patients. All studies were observational and of low to moderate quality. Mean age at symptom onset or at diagnosis ranged from 10 to 49 years and mean delay from symptom onset to diagnosis ranged from 2 months to 7.6 years. Study follow-up times were from 22 months to 17 years. The majority of studies had > 70% female subjects. The pooled prevalence of stroke in TAK was 8.9% (95% CI: 7.0-10.9%) and of MI was 3.4% (95% CI: 2.1-4.8%) at any time during the disease course. There was moderate-to-severe heterogeneity across the studies (stroke: I-2 = 64.9%; MI: I-2 = 74.0%). Other ischemic complications were inconsistently reported. Conclusion: Stroke and MI are common in TAK patients. Further studies are needed to identify predictors and preventative measures for severe ischemic events in TAK patients. (C) 2017 Elsevier Inc. All rights reserved.