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Rheumatoid arthritis increases risk for repeat revascularization after PCI
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Patients with rheumatoid arthritis have a 50% increased risk for repeat revascularization after PCI.
Researchers conducted a retrospective, single-center, matched-cohort study using electronic medical records on 143 patients (228 lesions) with rheumatoid arthritis and 541 matched controls (677 lesions) without rheumatoid arthritis who underwent PCI between 1996 and 2012.
The primary endpoint was target lesion revascularization and target vessel revascularization.
The TLR rate was 33% in rheumatoid arthritis lesions vs. 25% in control lesions (adjusted HR = 1.3; 95% CI, 0.97-1.8). The TVR rate was 39% in rheumatoid arthritis lesions vs. 31% in control lesions (adjusted HR = 1.15; 95% CI, 0.82-1.6).
Although the time to event analysis and shared frailty Cox proportional hazard models revealed a trend toward increased TLR and TVR in lesions of patients with rheumatoid arthritis vs. controls, these differences did not reach significance. In an interaction analysis designed to determine whether any predictors of TVR were more significant in rheumatoid arthritis lesions, the researchers found that lesions in women with rheumatoid arthritis had a significantly higher risk for TVR vs. lesions in men with rheumatoid arthritis. No important interaction was identified in rheumatoid arthritis lesions of patients with diabetes, bare-metal stent use or bifurcation lesions.
Analysis excluding lesions with revascularization events or follow-up less than 1 year revealed a significant hazard for TLR (adjusted HR = 1.48; 95% CI, 1.03-2.14) and TVR (adjusted HR = 1.55; 95% CI, 1.12-2.14). The lesions of patients with rheumatoid arthritis treated with methotrexate, tumor necrosis factor-alpha inhibitors or both at discharge had comparable TVR and TLR rates as controls, whereas lesions from patients with rheumatoid arthritis not treated with these agents demonstrated significantly more TLR (adjusted HR = 1.48; 95% CI, 1.08-2.03) and TVR (adjusted HR = 1.38; 95% CI, 1.04-1.84).
“[Rheumatoid arthritis] is a known risk factor for [CVD], and here we show that it is also a risk factor for adverse outcomes after PCI, namely, an increased risk of repeat revascularization,” the researchers wrote. “Clinicians treating this population should be aware of this risk when evaluating patients after PCI.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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