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The impact of inflammatory rheumatic diseases on the presentation, severity, and outcome of acute coronary syndrome

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Abstract

Patients with inflammatory rheumatic diseases (IRD) have a high burden of cardiovascular disease (CVD), leading to increased mortality and morbidity. However, it is not clear whether increased CVD mortality in IRD is due to a higher incidence or worse outcome of cardiovascular events (higher case fatality). In this observational case–control study, we assessed the outcome of acute coronary syndrome (ACS) in patients with IRDs compared to matched controls without IRD, using data from the Acute Coronary Syndrome Israeli Survey (ACSIS), a large, national, real-life registry detailing the extent, severity, and outcome of ACS. Of 2,193 subjects enrolled to the ACSIS, 20 (nine men) were identified with IRD, including 11 patients with rheumatoid arthritis, five patients with systemic lupus erythematosus (SLE), three patients with ankylosing spondylitis (AS), and one patient with psoriatic arthritis (PsA). The study patients were compared to 120 matched control patients (adjusted for age and risk factors for CVD) without IRD. Compared to controls, IRD patients had similar clinical presentation and similar type of ACS and received identical initial treatment at the ER. The two groups had comparable rates of complications including major adverse cardiovascular events (death, recurrent myocardial infarction, stroke, major bleeding, and definite stent thrombosis) (10 vs. 11.7 % in the study and control group, respectively, p > 0.05), re-hospitalization (20 vs. 21.1 %, respectively, p > 0.05), and severe congestive heart failure (7.7 vs. 6.9 %, respectively, p > 0.05) within 30 days. The outcome and prognosis of ACS in patients with IRD is not worse than that of control, supporting the higher prevalence of CVD in this population as the cause for their excess mortality.

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References

  1. Avina-Zubieta JA et al (2008) Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 59(12):1690–1697

    Article  PubMed  Google Scholar 

  2. del Rincon ID et al (2001) High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 44(12):2737–2745

    Article  PubMed  Google Scholar 

  3. Douglas KM et al (2006) Excess recurrent cardiac events in rheumatoid arthritis patients with acute coronary syndrome. Ann Rheum Dis 65(3):348–353

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Esdaile JM et al (2001) Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 44(10):2331–2337

    Article  PubMed  CAS  Google Scholar 

  5. Manzi S et al (1997) Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 145(5):408–415

    Article  PubMed  CAS  Google Scholar 

  6. Gladman DD et al (2009) Cardiovascular morbidity in psoriatic arthritis. Ann Rheum Dis 68(7):1131–1135

    Article  PubMed  CAS  Google Scholar 

  7. Peters MJ et al (2004) Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 34(3):585–592

    Article  PubMed  Google Scholar 

  8. Peters MJ et al (2010) Signs of accelerated preclinical atherosclerosis in patients with ankylosing spondylitis. J Rheumatol 37(1):161–166

    Article  PubMed  Google Scholar 

  9. Peters MJ et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69(2):325–331

    Article  PubMed  CAS  Google Scholar 

  10. Desai SP et al (2010) Comparison of symptoms, treatment, and outcomes of coronary artery disease among rheumatoid arthritis and matched subjects undergoing percutaneous coronary intervention. Semin Arthritis Rheum 40(3):215–221

    Article  PubMed  PubMed Central  Google Scholar 

  11. Francis ML et al (2010) Outcomes in patients with rheumatoid arthritis and myocardial infarction. Am J Med 123(10):922–928

    Article  PubMed  Google Scholar 

  12. McCoy SS et al (2013) Longterm outcomes and treatment after myocardial infarction in patients with rheumatoid arthritis. J Rheumatol 40(5):605–610

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. Van Doornum S et al (2006) Increased case fatality rates following a first acute cardiovascular event in patients with rheumatoid arthritis. Arthritis Rheum 54(7):2061–2068

    Article  PubMed  Google Scholar 

  14. Van Doornum S et al (2010) Rheumatoid arthritis patients receive less frequent acute reperfusion and secondary prevention therapy after myocardial infarction compared with the general population. Arthritis Res Ther 12(5):R183

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ben-Dor I et al (2006) Prognostic implications of increased cardiac biomarkers and ST segment depression in non-ST elevation acute coronary syndromes: lessons from the acute coronary syndrome Israeli survey (ACSIS) 2002. Heart 92(4):547–548

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  16. Sodergren A et al (2007) Increased incidence of and impaired prognosis after acute myocardial infarction among patients with seropositive rheumatoid arthritis. Ann Rheum Dis 66(2):263–266

    Article  PubMed  PubMed Central  Google Scholar 

  17. Krishnan E, Lingala VB, Singh G (2004) Declines in mortality from acute myocardial infarction in successive incidence and birth cohorts of patients with rheumatoid arthritis. Circulation 110(13):1774–1779

    Article  PubMed  Google Scholar 

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Correspondence to Ilan Ben-Zvi.

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Ben-Zvi, I., Goldenberg, I., Matetzky, S. et al. The impact of inflammatory rheumatic diseases on the presentation, severity, and outcome of acute coronary syndrome. Clin Rheumatol 35, 233–237 (2016). https://doi.org/10.1007/s10067-014-2695-y

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  • DOI: https://doi.org/10.1007/s10067-014-2695-y

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