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Active IBD worsened prognosis after MI
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Patients with active inflammatory bowel disease had increased risk for adverse cardiovascular outcomes after myocardial infarction, especially with disease flares, according to new research data.
“Our study shows that patients with active IBD at time of first MI have an increased short-term mortality,” Søren L. Kristensen, MD, PhD, department of cardiology, Copenhagen University Hospital, told Healio.com/Gastroenterology. “Among patients alive 30-days post-discharge after a first-time MI, those with IBD have a modestly increased risk of death, and major adverse cardiovascular events. However, this risk was strongly correlated to IBD activity, indicating that patients with active IBD are particularly [at risk], and that increased vigilance is warranted toward both CV and gastrointestinal symptoms and treatment in the period following an MI in these patients.”
Søren L. Kristensen
Aiming to determine the effect of active IBD on short-term mortality and long-term risk for CV adverse events after first-time MI, Kristensenand colleagues performed a nationwide historical cohort study of 86,790 patients (1,030 of whom had IBD) hospitalized with first-time MI from 2002 to 2011. Patients with IBD were categorized based on disease activity stage as either flare (120 days; n=110), persistent (>120 days; n=89) or remission (n=831). Risks for short-term mortality and recurrent MI all-cause mortality were estimated, as was the combined risk for recurrent MI, CV death and stroke.
The adjusted ORs for death during hospitalization or within 30 days of discharge for patients with IBD were 3.29 for the flare group (95% CI, 1.98-5.45), 1.62 for the persistent group (95% CI, 0.95-2.77) and 0.97 for those in remission (95% CI, 0.78-1.19) vs. patients without IBD. Among the 73,451 patients alive 30 days after discharge (mean age, 68.4 years; 36.9% women; 1.2% with IBD; mean follow-up, 3.9 years), overall risk for recurrent MI was similar between patients with and without IBD. However, the risk was increased for the flare group (HR=3.09; 95% CI, 1.79-5.32) and the persistent group (HR=1.98; 95% CI, 1.09-3.61) but not the remission group (HR=1.03; 95% CI, 0.81-1.31).
This trend was similar for all-cause mortality, with a slight increase in overall risk (HR=1.14; 95% CI, 1.01-1.28), a twofold greater risk in the flare (HR=2.25; 95% CI, 1.61-3.15) and persistent groups (HR=2.04; 95% CI, 1.53-2.73), but a similar risk in the remission group (HR=0.95; 95% CI, 0.83-1.1).
The same pattern was also observed in the combined risk for recurrent MI, CV death and stroke, with slight increase in overall risk (HR=1.17; 95% CI, 1.03-1.34), heightened risk for the flare (HR=2.04; 95% CI, 1.35-3.06) and persistent groups (HR=1.73; 95% CI, 1.19-2.5), but not in the remission group (HR=1.06; 95% CI, 0.91-1.23). – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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