Clinical characteristics and outcomes of patients with chronic systemic inflammatory disease in acute myocardial infarction

Abstract

Background Chronic systemic inflammatory diseases (CSIDs) such as rheumatoid arthritis (RA) are reportedly associated with an increased risk of ischemic cardiovascular events including acute myocardial infarction (MI). However, data are limited on clinical characteristics and ischemic and bleeding outcomes after acute MI in patients with CSIDs. Methods This bi-center registry included a total of 1001 patients with acute MI undergoing percutaneous coronary intervention. CSIDs included inflammatory rheumatological conditions (RA, systemic lupus erythematosus, vasculitis, etc.) and organ-specific diseases (chronic hepatitis, psoriasis, inflammatory bowel disease, etc.). The primary endpoint was net adverse clinical events (NACE), a composite of ischemic (all-cause death, MI, and ischemic stroke) and major bleeding (Bleeding Academic Research Consortium type 3 or 5) events, during hospitalization and after discharge. Results Of the 1001 patients, 58 (5.8%) had CSIDs. The proportion of women was higher in patients with CSIDs than those without (37.9% vs. 22.1%, p = 0.009). During the hospitalization, no significant differences in the primary endpoint of NACE were observed between patients with and without CSIDs (10.3% vs. 12.7%, p = 0.84). During the median follow-up of 42.6 months after discharge, patients with CSIDs had a higher risk of NACE (22.5% vs. 10.1%, p = 0.01) than those without, mainly driven by an increased risk of ischemic events (18.4% vs. 8.4%, p = 0.03). Conclusions A small but significant proportion of patients with acute MI (5.8%) had CSIDs. While the incidence of in-hospital events was similar, patients with CSIDs had worse outcomes after discharge, suggesting that further clinical investigations and therapeutic approaches are needed in this patient subset.

Meta-Analysis on the Impact of Inflammatory Rheumatological Conditions on Outcomes Following Acute Coronary Syndrome

“…Prior research has demonstrated that individuals afflicted with inflammatory rheumatological conditions, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), face an elevated risk of experiencing cardiovascular events, including myocardial infarction (MI) [6,7]. Moreover, when these patients develop coronary artery disease, including acute MI, it has been observed that their subsequent clinical outcomes are less favorable compared to those without such conditions [8,9]. This indicates that the presence of inflammatory rheumatological conditions may exacerbate the severity of coronary artery disease and its associated complications [3].…”

No Standard Risk Factors Is the Marker for Clinical Outcomes in Patients With Myocardial Infarction

“… 10 , 11 Furthermore, AMI patients with CSIDs may have worse clinical outcomes after the hospital discharge. 12 …”