What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial Infarction in Rheumatoid Arthritis (n=231). Intervention: Rheumatoid Arthritis vs. No Rheumatoid Arthritis. Primary outcome: Longterm mortality (5-year rate) (HR 1.47, 95% CI 1.04-2.08, p=0.036).

February 15, 2013Open Access

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

Key Result

Rheumatoid arthritis was associated with a significantly higher risk of longterm mortality (HR 1.47) and recurrent ischemia (HR 1.51) following myocardial infarction compared to matched patients without rheumatoid arthritis.

Study Design

Type

Cohort (n=231)

Multicenter

Structured PICO

Do patients with rheumatoid arthritis have worse long-term outcomes after myocardial infarction compared to patients without rheumatoid arthritis?

Population

231 adults (mean age 72.4 years, 55% female) with incident myocardial infarction, including 77 with rheumatoid arthritis and 154 matched controls without rheumatoid arthritis, followed for a median of 2.6 to 2.7 years.

Exposure

Rheumatoid arthritis (RA)

Comparator

Matched MI patients without RA

Outcome

Longterm outcomes including mortality, heart failure, and recurrent ischemiahard clinical

Despite similar acute treatment, patients with rheumatoid arthritis have significantly worse long-term mortality and recurrent ischemia following myocardial infarction compared to those without RA.

Main Result

Hazard Ratio: 1.47 (95% CI 1.04–2.08)

Absolute Event Rate: 57% vs 36%

p-value: p=0.036

Limitations

Retrospective design limited to information available from medical records
Data on treatment therapy of modifiable risk factors and nonsteroidal antiinflammatory agents was not collected
Unable to obtain data on the disease activity of patients at the time of MI
Limited statistical power to detect associations between RA disease characteristics and MI outcomes
Predominately white population in Olmsted County limits generalizability to more diverse populations

Abstract

OBJECTIVE: To investigate the risk profiles, treatment, and outcomes of patients with rheumatoid arthritis (RA) with myocardial infarction (MI) and matched MI patients without RA. METHODS: We used a population-based cohort of Olmsted County, Minnesota, residents with MI from the period 1979-2009. We identified 77 patients who fulfilled the American College of Rheumatology 1987 criteria for RA and 154 MI patients without RA matched for age, sex, and calendar year. Data collection from medical records included RA and MI characteristics, antirheumatic and cardioprotective medications, reperfusion therapy, and outcomes (mortality, heart failure, and recurrent ischemia). RESULTS: The mean age at MI was 72.4 years and 55% of patients 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 those without RA. Patients with RA experienced poorer longterm outcomes compared to patients without RA--for mortality: hazard ratio (HR) 1.47; 95% CI 1.04, 2.08; and for recurrent ischemia: HR 1.51; 95% CI 1.04, 2.18. CONCLUSION: MI patients with RA received similar treatment with reperfusion therapy and cardioprotective medications and had similar short-term outcomes compared to patients without RA. Patients with RA had poorer longterm outcomes. Despite similar treatment, MI patients with RA had worse longterm outcomes than MI patients without RA.

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