Autoimmune diseases tied to worse outcomes after heart attack: JAHA
Cleveland, OH: Patients with a rheumatic immune-mediated inflammatory disease (IMID) and myocardial infarction (MI) are at greater risk of worse outcomes, particularly for mortality, compared with patients without an IMID, findings from a large propensity-matched analysis show. The findings appeared in the Journal of the American Heart Association on 14 Sep 2022.
The worse outcomes that the patients experienced during follow-up were risk of heart failure, mortality, need for coronary intervention, and recurrent MI.
IMIDs are chronic conditions characterized by inflammation and immune dysregulation. IMIDs include the spondyloarthritis disease spectrum, rheumatoid arthritis (RA), connective tissue disorders, cutaneous inflammatory conditions such as atopic dermatitis and psoriasis, asthma, inflammatory bowel disease, and autoimmune neurological diseases such as multiple sclerosis.
Rheumatic IMIDs are linked with a high risk of the acute coronary syndrome. There is no clarity on the long-term prognosis of an acute coronary syndrome in rheumatic IMIDs patients. Considering this, Amgad Mentias, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, and colleagues aimed to investigate the management and midterm outcomes of MI in patients with versus without rheumatic IMIDs by utilizing a current nationwide database.
For this purpose, the researchers identified Medicare beneficiaries hospitalized with a diagnosis of myocardial infarction from 2014 to 2019. The researchers compared outcomes of patients with MI and rheumatic IMIDs, including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, systemic sclerosis, or psoriasis propensity-matched control patients without rheumatic IMIDs.
The study cohort consisted of 1 654 862 patients with a 3.6% prevalence of rheumatic IMIDs, rheumatoid arthritis being the most common type, followed by systemic lupus erythematosus. They performed one‐to‐three propensity‐score matching for the same sex, age, race, ST‐segment–elevation MI, and non–ST‐segment–elevation MI variables. All-cause mortality was the study's primary outcome.
The study led to the following findings:
- Rheumatic IMIDs patients were younger, more likely to be women, and more likely to present with non–ST‐segment–elevation MI.
- Rheumatic IMIDs patients were less likely to undergo coronary angiography, percutaneous coronary intervention, or coronary artery bypass grafting.
- After propensity‐score matching, at a median follow-up of 24 months, the risk of mortality (adjusted hazard ratio [HR], 1.15), heart failure (HR, 1.12), recurrent MI (HR, 1.08), and coronary reintervention (HR, 1.06) was higher in patients with versus without rheumatic IMIDs.
"Our findings revealed that in Medicare patients above 65 years of age and with rheumatic IMIDs history presenting with myocardial infarction, coronary interventions were less utilized, and clinical outcomes including heart failure, mortality, need for coronary intervention, and recurrent MI significantly worse than in patients without rheumatic IMIDs," the researchers wrote in their study.
The authors suggest offering coronary intervention, medical therapy intensification, and aggressive risk factor optimization to these patients whenever feasible clinically to mitigate this increased risk.
Reference:
The study titled "Outcomes Following Acute Coronary Syndrome in Patients With and Without Rheumatic Immune‐Mediated Inflammatory Diseases," was published in the Journal of the American Heart Association. DOI: https://doi.org/10.1161/JAHA.122.026411
