RA patients at higher risk of death, rehospitalization after heart attack: Study
Finland: Rheumatoid arthritis (RA) patients are at a higher risk for long-term poor outcomes following a heart attack (myocardial infarction), a recent study in the journal Rheumatology has revealed.
Antti Palomäki, Department of Medicine, University of Turku, Turku, Finland, and colleagues aimed to investigate the long-term outcomes of patients with rheumatoid arthritis (RA) after myocardial infarction (MI).
For the purpose, the researchers conducted a multicenter, nationwide, cohort register study in Finland. They retrospectively compared all-comer, real-life MI patients with RA (n = 1614, mean age 74 years) to propensity score (1:5) matched MI patients without RA (n = 8070).
The impact of RA duration and the usage of corticosteroids and antirheumatic drugs on RA patients' outcomes were also studied. The median follow-up was 7.3 years.
Key findings of the study include:
- RA was associated with an increased 14-year mortality risk after MI compared to patients without RA (80.4% vs. 72.3%; HR 1.25).
- Patients with RA were at higher risk of new MI (HR 1.22) and revascularisation (HR 1.28) after discharge from index MI.
- Cumulative stroke rate after MI did not differ between RA and non-RA patients.
- RA duration and corticosteroid usage before MI, but not use of methotrexate or biologic antirheumatic drugs, were independently associated with higher mortality and new MI.
- A higher dosage of corticosteroids prior to MI was independently associated with higher long-term mortality and methotrexate usage with lower stroke rate.
- Serological status of RA was not associated with outcomes.
"RA is independently associated with poorer prognosis after MI. RA duration and corticosteroid usage and dosage were independent predictors of mortality after MI in RA," wrote the authors. "Special attention is needed for improvement of outcomes after MI in this vulnerable population."
The study titled, "Patients with rheumatoid arthritis have impaired long-term outcomes after myocardial infarction – a nationwide case-control registry study," is published in the journal Rheumatology.