Rheumatoid arthritis was associated with a more severe presentation of acute coronary syndrome and higher 30-day mortality compared to the general population (adjusted HR 1.36; 95% CI 1.13-1.64).
Cohort (n=4,319)
Does prevalent rheumatoid arthritis worsen the clinical presentation and increase short-term mortality in patients with incident acute coronary syndrome?
Patients with rheumatoid arthritis presenting with acute coronary syndrome have a more severe clinical presentation and significantly higher short-term mortality compared to the general population, which is only partially explained by event severity.
Effect estimate: HR 1.36 (95% CI 1.13-1.64)
AIMS: Despite a wealth of studies describing an increased incidence of acute coronary syndromes (ACSs) in rheumatoid arthritis (RA), considerably less is known about the clinical characteristics and their association with short-term outcome of such ACS. The aims of this study were therefore to investigate clinical characteristics and case-fatality rates following ACS in patients with RA. METHODS AND RESULTS: We compared the clinical presentation of incident ACS between 2007 and 2010 and their short-term mortality in a cohort of 1135 subjects with prevalent RA and in a cohort of 3184 matched general population comparators. Rheumatoid arthritis subjects more frequently presented with sudden cardiac death, ST-segment elevation myocardial infarctions, had higher levels of troponin and higher frequencies of in-hospital complications compared with the general population comparators. Furthermore, the short-term mortality was higher among RA-associated ACS (7-day hazard ratio (HR) = 1.65 95% CI 1.32-2.08; 30-day HR = 1.57 95% CI 1.30-1.89), which were somewhat attenuated but remained statistically significantly increased following adjustment for previous comorbidities, demographics, and educational level (7-day HR = 1.50 95% CI 1.19-1.90; 30-day HR = 1.43 95% CI 1.18-1.72), and for ACS type (7-day HR = 1.44 95% CI 1.14-1.82; 30-day HR = 1.36 95% CI 1.13-1.64). CONCLUSION: Patients with prevalent RA suffer more severe ACSs compared with the general population and also have poorer outcomes after the events, which can only partly be explained by increased event severity.
Mantel et al. (Wed,) conducted a cohort in Acute coronary syndrome and rheumatoid arthritis (n=4,319). Rheumatoid arthritis vs. Matched general population was evaluated on 30-day mortality (adjusted for comorbidities, demographics, education, and ACS type) (HR 1.36, 95% CI 1.13-1.64). Rheumatoid arthritis was associated with a more severe presentation of acute coronary syndrome and higher 30-day mortality compared to the general population (adjusted HR 1.36; 95% CI 1.13-1.64).