Longterm Outcomes and Treatment After Myocardial Infarction in Patients with Rheumatoid Arthritis

Abstract

Objective To investigate the risk profiles, treatment utilization, and outcomes of myocardial infarction (MI) patients with rheumatoid arthritis (RA) and matched MI patients without RA. Methods We utilized a population-based cohort of Olmsted County, Minnesota, residents with MI from 1979–2009. Among these, we identified 77 patients who fulfilled the American College of Rheumatology (ACR) 1987 criteria for RA and 154 age, sex, and calendar year matched MI patients without RA. Data collection from medical records included RA and MI characteristics, antirheumatic and cardioprotective medications, and reperfusion therapy as well as outcomes (mortality, heart failure, and recurrent ischemia). Results The mean age at MI was 72.4 and 55% were female in both cohorts. Cardiovascular risk factor profiles, MI characteristics, and treatment with reperfusion therapy or cardioprotective medications were similar in MI patients with and without RA. However, patients with RA experienced poorer long-term outcomes compared to patients without RA (for mortality: hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.04, 2.08, and for recurrent ischemia: HR: 1.51; 95% CI: 1.04, 2.18). Conclusion MI patients with RA receive similar treatment with reperfusion therapy and cardioprotective medications, and have similar short-term outcomes compared to patients without RA. However, patients with RA have poorer long-term outcomes. Thus, despite similar treatment, MI patients with RA have worse long-term outcomes than MI patients without RA.

Cardiovascular disease assessment in rheumatoid arthritis: a guide to translating knowledge of cardiovascular risk into clinical practice

“…Further, despite similar treatment, patients with RA who had a myocardial infarction had worse long-term outcomes than those without RA 31. This deficiency in CVD risk management is amply confirmed in an investigation of CVD risk factor control in 836 patients with RA by Primdahl and colleagues 32.…”

Prognosis After First-Time Myocardial Infarction in Patients With Inflammatory Bowel Disease According to Disease Activity

“…No previous studies of post-MI prognosis in patients with IBD have been reported, but the association between IBD and worsened prognosis after MI is in line with findings in other chronic inflammatory diseases, including rheumatoid arthritis and psoriasis. 25,26 The observation of a relationship between adverse cardiovascular events and active stages of IBD further suggests that inflammation plays a central role in the association between IBD and atherothrombotic events. Indeed, the arterial and systemic immune-inflammatory processes implicated in atherosclerosis and atherothrombotic events bear many resemblances to the intestinal and systemic inflammation seen in active IBD.…”

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

“…Several studies over last 20 years showed that patients with RA have significantly higher risk of coronary heart disease (CHD) when compared with non-RA subjects. Patients with RA are more likely to experience unrecognized myocardial infarction and sudden death and, they also have poorer long-term outcomes than those with myocardial infarction without RA [10,17]. The influence of traditional risk factors and chronic systemic inflammation is described in this article.…”