Vascular, inflammatory and immune factors associated with acute ischemic events in Takayasu arteritis: a 10-year retrospective matched case-control study.

OBJECTIVES: Acute ischemic events (AIE) constitute life-threatening complications of Takayasu arteritis (TAK). This study aimed to identify vascular, inflammatory and immune factors associated with concurrent AIE in TAK patients. METHODS: We conducted a 10-year retrospective 1:2 matched case-control study including TAK patients without exposure to glucocorticoids, immunosuppressants, or antithrombotic agents for at least 3 months. Clinical characteristics, disease activity, inflammatory markers, and lymphocyte subsets were compared between patients with and without AIE. Three sequential multivariable logistic regression models were constructed to identify variables independently associated with AIE. Model discrimination was evaluated using receiver operating characteristic (ROC) analysis with 1000-bootstrap internal validation, while calibration and decision curve analysis (DCA) were performed as exploratory within-sample assessments. RESULTS: Thirty-seven patients with AIE and 74 matched TAK control without AIE were included. The mean age at TAK onset in the AIE group was 34.92 ± 10.83 years (range: 16-58 years). Conventional markers including ESR, CRP and homocysteine showed no independent correlation with AIE. Patients with AIE presented substantially higher frequencies of coronary, anterior cerebral, middle cerebral, and femoral artery stenosis, alongside significantly elevated ITAS-2010 scores, serum IgA and IL-6 levels, and peripheral Th cell counts (all p < 0.05). Severe long-term functional sequelae were also more frequent in the AIE group. Multivariate analysis confirmed that stenosis at these four arterial sites, together with elevated ITAS-2010 score, IgA, IL-6, and Th cell counts, were independently associated with AIE. The fully integrated vascular-inflammation-immunity model yielded an apparent AUC of 0.942 (95%CI 0.898-0.985) and a bootstrap optimism-corrected AUC of 0.908 (95%CI 0.843-0.959), with a corrected Brier score of 0.1191. Calibration and DCA supported satisfactory within-sample model performance but should be interpreted as exploratory because of the matched case-control design. CONCLUSIONS: Specific vascular stenosis, high disease activity, elevated serum IgA and IL-6 levels, and increased peripheral Th cell counts are independently associated with AIE in TAK. These findings provide additional insight into the vascular, inflammatory, and immune characteristics accompanying ischemic complications in TAK and warrant confirmation in prospective multicenter studies.