Long-term outcomes after acute coronary syndrome in patients with rheumatoid arthritis
J Sulicka-Grodzicka, D Ciesla, K Wita, M Gasior, M KorkoszAbstract
Background
The mortality rate in patients with rheumatoid arthritis (RA) has been estimated to be increased by approximately 50% compared with general population, and cardiovascular diseases are the most frequent cause of death in RA patients. However, it is unclear whether the changes in RA treatment strategies over the past two decades have altered cardiovascular morbidity and mortality in this population.
Purpose
To examine long-term outcomes after acute coronary syndrome (ACS) in RA.
Methods
We used data from Silesian Cardiovascular Database (SILCARD) which is based on the data from the Regional Department of the National Health Fund (NHF) in Poland. We included in the analysis consecutive adult patients who presented with ACS, admitted between January 2010 and December 2022 to participating hospitals, who were identified using ICD-10 codes for primary discharge diagnosis. Patients with prevalent RA were recognized from the registry database using ICD-10 codes. Baseline characteristics, co-morbidities, and outcomes during index hospitalization, within 12 months and 3 years from hospital discharge were obtained from hospital records and NHF. The primary endpoint was the time to the first MACE (major adverse cardiovascular event including all-cause death, recurrent non-fatal acute myocardial infarction (MI), unstable angina (UA), stroke). Cox proportional hazard ratio (HR) was calculated to estimate associations and adjusted for confounding (age, sex, comorbidities, revascularization for index ACS).
Results
A total of 196 588 patients with ACS (mean age 67.3±11 years, 38.2% women), including 9 232 patients with prevalent RA were enrolled. Patients with RA were older, more often female and had a higher burden of comorbidities than individuals without rheumatoid arthritis, with the exception of stroke (Table). Revascularization by percutaneous coronary intervention was performed in a comparable proportion of patients in both groups (61.3% in RA vs. 62.1% in non-RA group, P=0.122), and coronary artery bypass graft surgery was performed less frequently in RA than in non-RA patients (8.6% vs.9.6%; P=0.002). During 12 months and 3 years after discharge for index ACS both groups experienced similar rates of MI, stroke and all-cause mortality, patients with RA had higher rates of hospitalization. In the Cox regression model, the relative rate of MACE during follow-up after discharge for index ACS was 3.4% higher among participants with RA compared to patients without RA (adjusted HR 1.034; 95% Confidence Interval 1.003 – 1.066; P =0.032).
Conclusion
Our findings suggests that, during 3 years following ACS, patients with RA experience a modestly elevated risk of MACE compared with individuals without RA. These results underscore the importance of early risk stratification, rigorous management of modifiable cardiovascular risk factors, and optimal control of systemic inflammation in this population.