Association of Systemic Sclerosis With Premature Ventricular Complexes and Cardiac Arrest: A National Inpatient Sample Analysis for 2021

TL;DR

This study finds that patients with systemic sclerosis have a higher risk of premature ventricular complexes and cardiac arrest compared to the general population.

Contribution

The study provides new evidence that systemic sclerosis is independently associated with PVC and cardiac arrest after adjusting for comorbidities.

Findings

Systemic sclerosis is associated with increased odds of PVC and cardiac arrest.

Multivariate analysis confirmed independent associations with PVC and cardiac arrest.

No significant associations were found for ventricular tachycardia or ventricular fibrillation.

Abstract

Background: Systemic sclerosis (SSc) is a connective tissue disorder known to have multiple cardiovascular manifestations, including pulmonary fibrosis with pulmonary arterial hypertension, heart failure, and coronary artery disease. Arrhythmias, particularly ventricular arrhythmias, including premature ventricular complexes (PVC), ventricular tachycardia (VT), and ventricular fibrillation (VF), have been reported in patients with systemic sclerosis, but large-scale studies on their frequency and outcomes are limited.

Objective: We aimed to investigate whether SSc predisposes patients to ventricular arrhythmias and cardiac arrest, providing critical information for risk stratification and clinical management.

Methods: We analyzed discharges with a primary or secondary diagnosis of SSc (ICD-10 code M34). We compared the occurrence of PVC, VT, VF, and cardiac arrest between patients with SSc and those without. Univariate logistic regression was used to identify associations between SSc and arrhythmic events. Multivariate regression, adjusted for age, gender, smoking history, myocardial infarction, heart failure, hypertension, chronic kidney disease, and pulmonary fibrosis, was performed to assess independent associations. Statistical analyses were conducted using STATA 18.

Results: Among 28,729 discharges with a diagnosis of systemic sclerosis, univariate logistic regression showed significant associations between SSc and both PVC (OR 1.32; p=0.02) and cardiac arrest (OR 1.46; p<0.001). However, no significant associations were found for VT (p=0.5) and VF (p=0.6). After adjusting for confounders in multivariate logistic regression, PVC (OR 1.29; p=0.034) and cardiac arrest (OR 1.47; p<0.001) remained significantly associated with SSc, while VT (p=0.555) and VF (p=0.756) did not.

Conclusion: Patients with SSc experience a higher frequency of PVC and cardiac arrest compared to the general population, even after adjusting for comorbid risk factors. These findings highlight the importance of close cardiac monitoring in this patient population to enable early detection and management of arrhythmias. Future prospective studies are needed to further explore the role of fibrosis, long-term arrhythmia burden, and clinical outcomes in SSc.