RA independently linked to poorer prognosis after myocardial infarction
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Rheumatoid arthritis is independently linked to worse prognosis following myocardial infarction, with disease duration and corticosteroid use predicting mortality after myocardial infarction, according to data published in Rheumatology.
“The increased prevalence of atherosclerotic [cardiovascular disease (CVD)] and [myocardial infarction (MI)] among patients with RA is well documented, but less is known about the outcomes after MI,” Antti Palomäki, MD, of Turku University Hospital, in Finland, and colleagues wrote. “Several studies have focused on short-term outcomes after MI and most, but not all, have reported increased in-hospital or 30-day mortality among RA patients compared to controls without RA. A few small studies on the long-term outcomes of MI among RA patients have reported excess mortality and recurrent ischemia.”
“To our knowledge, only a few large-scale registry studies from Sweden and Taiwan have reported impaired long-term survival among RA patients after acute coronary syndrome, and they did not explore the effects of disease-modifying antirheumatic drugs or glucocorticoids on survival,” they added. “Conflicting results exist on whether RA patients are undertreated in secondary prevention after MI compared to patients without RA.”
To analyze the long-term outcomes of patients with RA following myocardial infarction, Palomäki and colleagues conducted a nationwide registry study. Using data from hospitals participating in the Care Register for Healthcare in Finland, the researchers compared 1,614 all-comer, real-life adults with RA and myocardia infarction to 8,070 matched patients with myocardial infarction but without RA. All participants had been admitted between Jan. 1, 2005, and Dec. 31, 2014, and were matched 1:5 based on propensity score.
The primary outcome was all-cause mortality. Secondary outcomes included new myocardial infarction, stroke, revascularization and cardiovascular medication usage following myocardial infarction. The researchers also examined the effect of glucocorticoids and DMARDs on outcomes following myocardial infarction.
According to the researchers, the cumulative all-cause mortality rate after myocardial infarction, at the end of 14 years of follow-up, was 80.4% in patients with RA, compared with 72.3% in those without RA (HR = 1.25; CI, 1.16-1.35). In addition, patients with RA demonstrated a higher risk for new myocardial infarction (HR = 1.22; CI, 1.09-1.36) and revascularization (HR = 1.28; CI, 1.10-1.49) following an initial myocardial infarction. However, the cumulative stroke rate after myocardial infarction did not differ between those with and without RA (P=.322).
Meanwhile, RA disease duration and corticosteroid use prior to myocardial infarction were independently linked with higher mortality (P<.001) and new myocardial infarction (P=.009). A higher dose of corticosteroids prior to myocardial infarction was also independently associated with higher long-term mortality (P=.002), while methotrexate was linked to lower rates for stroke (P=.034).
“Our study demonstrated that RA is independently associated with a worse prognosis after MI during long-term follow-up,” Palomäki and colleagues wrote. “Longer RA disease duration and glucocorticoid use were independent predictors of mortality, while methotrexate use was associated with a lower stroke risk.”
“Secondary prevention with statins was less frequent in patients with RA, and given the survival disadvantage, secondary prevention in RA warrants particular attention,” they added. “Patients with RA who suffer a myocardial infarction could benefit from a comprehensive evaluation and optimization of treatment to improve long-term outcomes.”
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