Acute Myocardial Infarction in Autoimmune Rheumatologic Disease: A Nationwide Analysis of Clinical Outcomes and Predictors of Management Strategy
| Autor: | Lorna Clarson, Toby Helliwell, David L. Fischman, Mirvat Alasnag, Lina Ya'qoub, Abhishek Abhishek, Mamas A. Mamas, Christian D Mallen, Mohamed O. Mohamed, Khalid Al Shaibi, Chadi Alraies, Phyo K. Myint, Edward Roddy |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Q1 Coronary Angiography Coronary artery disease Percutaneous Coronary Intervention Interquartile range Internal medicine RC927 Cause of Death Rheumatic Diseases medicine Prevalence Humans Lupus Erythematosus Systemic Myocardial infarction Coronary Artery Bypass skin and connective tissue diseases Stroke Aged Aged 80 and over Scleroderma Systemic business.industry Percutaneous coronary intervention General Medicine Odds ratio Middle Aged medicine.disease United States Rheumatoid arthritis Cohort Female business RA |
| Zdroj: | Mayo Clinic proceedings. 96(2) |
| ISSN: | 1942-5546 |
| Popis: | Objectives To examine national-level differences in management strategies and outcomes in patients with autoimmune rheumatic disease (AIRD) with acute myocardial infarction (AMI) from 2004 through 2014. Methods All AMI hospitalizations were analyzed from the National Inpatient Sample, stratified according to AIRD diagnosis into 4 groups: no AIRD, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSC). The associations between AIRD subtypes and (1) receipt of coronary angiography and percutaneous coronary intervention (PCI) and (2) clinical outcomes were examined compared with patients without AIRD. Results Of 6,747,797 AMI hospitalizations, 109,983 patients (1.6%) had an AIRD diagnosis (RA: 1.3%, SLE: 0.3%, and SSC: 0.1%). The prevalence of RA rose from 1.0% (2004) to 1.5% (2014), and SLE and SSC remained stable. Patients with SLE were less likely to receive invasive management (odds ratio [OR] [95% CI]: coronary angiography—0.87; 0.84 to 0.91; PCI—0.93; 0.90 to 0.96), whereas no statistically significant differences were found in the RA and SSC groups. Subsequently, the ORs (95% CIs) of mortality (1.15; 1.07 to 1.23) and bleeding (1.24; 1.16 to 1.31) were increased in patients with SLE; SSC was associated with increased ORs (95% CIs) of major adverse cardiovascular and cerebrovascular events (1.52; 1.38 to 1.68) and mortality (1.81; 1.62 to 2.02) but not bleeding or stroke; the RA group was at no increased risk for any complication. Conclusion In a nationwide cohort of AMI hospitalizations we found lower use of invasive management in patients with SLE and worse outcomes after AMI in patients with SLE and SSC compared with those without AIRD. |
| Databáze: | OpenAIRE |
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