Ischemic Vascular Complications in Early Systemic Sclerosis (SSc): A Longitudinal Inception Cohort Study of Associated Clinical Factors and Mortality

Background/Objectives: Predictors of ischemic vascular complications (IVCs)—including coronary artery disease (CAD), ischemic stroke, and digital gangrene—in patients with early SSc remain insufficiently defined. Therefore, we aim to determine the incidence, risk factors, and mortality associated with IVCs in early SSc. Methods: An inception cohort of patients with early SSc at the Rheumatology Clinic, Maharaj Nakorn Chiang Mai Hospital, Thailand, was studied from January 2010 to December 2023. Clinical, laboratory, and cardiopulmonary assessments were performed at baseline and annually thereafter. Results: A total of 146 patients (83 female, 119 DcSSc) were enrolled, with a mean disease duration of 11.5 ± 8.9 months from the first non-Raynaud’s phenomenon (NRP). The mean follow-up was 8.0 ± 3.9 years. Seventeen patients (11.6%) developed IVCs, three CAD, four ischemic stroke, eight digital gangrene, and two digital gangrene plus CAD. The median time to first IVCs was two years. The overall incidence rate of IVCs from the NRP was 1.44 per 100 person-years (95% CI 0.89–2.32). Independent factors associated with IVCs included baseline (BL) digital ulcer, traumatic ulcer, LVEF < 50%, elevated pro-BNP, and any atrial fibrillation. BL pro-BNP and dyslipidemia were independently associated with CAD, whereas BL pro-BNP and any atrial fibrillation were associated with ischemic stroke. BL digital ulcer, traumatic ulcer, and any LVEF < 50% were associated with digital gangrene. All-cause mortality was higher among patients with IVCs than those without (9 [52.9%] vs. 37 [28.7], p = 0.043). Conclusions: In this study, IVCs were uncommon in early SSc, but were associated with increased mortality. Digital ulcers, traumatic ulcers, atrial fibrillation, impaired LVEF, and elevated pro-BNP identified the patients at higher risk of IVCs.