Acute Myocardial Infarction in Autoimmune Rheumatologic Disease: A Nationwide Analysis of Clinical outcomes and Predictors of Management Strategy

Mohamed O. Mohamed; Edward Roddy; Lina Ya’qoub; Phyo K. Myint; Mirvat Al Alasnag; Chadi Alraies; Lorna Clarson; Toby Helliwell; Christian Mallen; David Fischman; Khalid Al Shaib; Abhishek Abhishek; Mamas A. Mamas

doi:10.1016/j.mayocp.2020.04.044

Acute Myocardial Infarction in Autoimmune Rheumatologic Disease: A Nationwide Analysis of Clinical outcomes and Predictors of Management Strategy

Mohamed O. Mohamed, Edward Roddy, Lina Ya’qoub, Phyo K. Myint, Mirvat Al Alasnag, Chadi Alraies, Lorna Clarson, Toby Helliwell, Christian Mallen, David Fischman, Khalid Al Shaib, Abhishek Abhishek, Mamas A. Mamas^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives: The present study sought to examine national-level differences in management strategies and outcomes in patients with autoimmune rheumatic disease (AIRD) with acute myocardial infarction (AMI) between 2004 and 2014.

Methods: All AMI hospitalizations were analyzed from National Inpatient Sample, stratified according to AIRD diagnosis into four 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 (CA) and percutaneous coronary intervention (PCI) and 2) clinical outcomes were examined in comparison to patients without AIRD.

Results: Out 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 has risen from 1.0% (2004) to 1.5% (2014) while SLE and SSC remained stable. Patients with SLE were less likely to receive invasive management (odds ratio (OR) CA:0.87; 95% confidence interval (CI) 0.84,0.91, PCI:0.93 0.90,0.96) whereas no statistically significant differences were found in RA and SSC groups. Subsequently, the odds of mortality and bleeding were increased in patients with SLE (OR 1.15; 1.07,1.23 and 1.24; 1.16,1.31, respectively). SSC was associated with increased odds of MACCE and mortality (OR 1.52; 1.38,1.68 and 1.81; 1.62,2.02, respectively) but not bleeding or stroke, whereas the RA group was at no increased risk of any complication.

Conclusion: In a nationwide cohort of AMI hospitalizations we demonstrate lower utilization of invasive management in patients with SLE and worse outcomes after AMI in SLE and SSC patients compared to those without AIRD.

Original language	English
Pages (from-to)	388-399
Number of pages	12
Journal	Mayo Clinic Proceedings
Volume	96
Issue number	2
Early online date	26 Nov 2020
DOIs	https://doi.org/10.1016/j.mayocp.2020.04.044
Publication status	Published - 1 Feb 2021

Bibliographical note

Funding
M.O.M is funded by an unrestricted educational PhD studentship from Medtronic Ltd. Medtronic Ltd was not involved in the conceptualization or design of the present study. C.M. is funded by the National Institute for Health Research (NIHR) Applied Research (West Midlands), the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice (NIHR-RP-2014-04-026). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, our funding bodies or the Department of Health and Social Care.

Keywords

acute myocardial infarction
rheumatoid arthritis
systemic sclerosis
systemic lupus erythematosus
outcomes
revascularization

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Mohamed, M. O., Roddy, E., Ya’qoub, L., Myint, P. K., Al Alasnag, M., Alraies, C., Clarson, L., Helliwell, T., Mallen, C., Fischman, D., Al Shaib, K., Abhishek, A., & Mamas, M. A. (2021). Acute Myocardial Infarction in Autoimmune Rheumatologic Disease: A Nationwide Analysis of Clinical outcomes and Predictors of Management Strategy. Mayo Clinic Proceedings, 96(2), 388-399. https://doi.org/10.1016/j.mayocp.2020.04.044

Mohamed, MO, Roddy, E, Ya’qoub, L, Myint, PK, Al Alasnag, M, Alraies, C, Clarson, L, Helliwell, T, Mallen, C, Fischman, D, Al Shaib, K, Abhishek, A & Mamas, MA 2021, 'Acute Myocardial Infarction in Autoimmune Rheumatologic Disease: A Nationwide Analysis of Clinical outcomes and Predictors of Management Strategy', Mayo Clinic Proceedings, vol. 96, no. 2, pp. 388-399. https://doi.org/10.1016/j.mayocp.2020.04.044

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title = "Acute Myocardial Infarction in Autoimmune Rheumatologic Disease: A Nationwide Analysis of Clinical outcomes and Predictors of Management Strategy",

abstract = "Objectives: The present study sought to examine national-level differences in management strategies and outcomes in patients with autoimmune rheumatic disease (AIRD) with acute myocardial infarction (AMI) between 2004 and 2014.Methods: All AMI hospitalizations were analyzed from National Inpatient Sample, stratified according to AIRD diagnosis into four 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 (CA) and percutaneous coronary intervention (PCI) and 2) clinical outcomes were examined in comparison to patients without AIRD.Results: Out 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 has risen from 1.0% (2004) to 1.5% (2014) while SLE and SSC remained stable. Patients with SLE were less likely to receive invasive management (odds ratio (OR) CA:0.87; 95% confidence interval (CI) 0.84,0.91, PCI:0.93 0.90,0.96) whereas no statistically significant differences were found in RA and SSC groups. Subsequently, the odds of mortality and bleeding were increased in patients with SLE (OR 1.15; 1.07,1.23 and 1.24; 1.16,1.31, respectively). SSC was associated with increased odds of MACCE and mortality (OR 1.52; 1.38,1.68 and 1.81; 1.62,2.02, respectively) but not bleeding or stroke, whereas the RA group was at no increased risk of any complication.Conclusion: In a nationwide cohort of AMI hospitalizations we demonstrate lower utilization of invasive management in patients with SLE and worse outcomes after AMI in SLE and SSC patients compared to those without AIRD.",

keywords = "acute myocardial infarction, rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus, outcomes, revascularization",

author = "Mohamed, {Mohamed O.} and Edward Roddy and Lina Ya{\textquoteright}qoub and Myint, {Phyo K.} and {Al Alasnag}, Mirvat and Chadi Alraies and Lorna Clarson and Toby Helliwell and Christian Mallen and David Fischman and {Al Shaib}, Khalid and Abhishek Abhishek and Mamas, {Mamas A.}",

note = "Funding M.O.M is funded by an unrestricted educational PhD studentship from Medtronic Ltd. Medtronic Ltd was not involved in the conceptualization or design of the present study. C.M. is funded by the National Institute for Health Research (NIHR) Applied Research (West Midlands), the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice (NIHR-RP-2014-04-026). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, our funding bodies or the Department of Health and Social Care.",

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doi = "10.1016/j.mayocp.2020.04.044",

language = "English",

volume = "96",

pages = "388--399",

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T1 - Acute Myocardial Infarction in Autoimmune Rheumatologic Disease

T2 - A Nationwide Analysis of Clinical outcomes and Predictors of Management Strategy

AU - Mohamed, Mohamed O.

AU - Roddy, Edward

AU - Ya’qoub, Lina

AU - Myint, Phyo K.

AU - Al Alasnag, Mirvat

AU - Alraies, Chadi

AU - Clarson, Lorna

AU - Helliwell, Toby

AU - Mallen, Christian

AU - Fischman, David

AU - Al Shaib, Khalid

AU - Abhishek, Abhishek

AU - Mamas, Mamas A.

N1 - Funding M.O.M is funded by an unrestricted educational PhD studentship from Medtronic Ltd. Medtronic Ltd was not involved in the conceptualization or design of the present study. C.M. is funded by the National Institute for Health Research (NIHR) Applied Research (West Midlands), the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice (NIHR-RP-2014-04-026). The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, our funding bodies or the Department of Health and Social Care.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - Objectives: The present study sought to examine national-level differences in management strategies and outcomes in patients with autoimmune rheumatic disease (AIRD) with acute myocardial infarction (AMI) between 2004 and 2014.Methods: All AMI hospitalizations were analyzed from National Inpatient Sample, stratified according to AIRD diagnosis into four 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 (CA) and percutaneous coronary intervention (PCI) and 2) clinical outcomes were examined in comparison to patients without AIRD.Results: Out 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 has risen from 1.0% (2004) to 1.5% (2014) while SLE and SSC remained stable. Patients with SLE were less likely to receive invasive management (odds ratio (OR) CA:0.87; 95% confidence interval (CI) 0.84,0.91, PCI:0.93 0.90,0.96) whereas no statistically significant differences were found in RA and SSC groups. Subsequently, the odds of mortality and bleeding were increased in patients with SLE (OR 1.15; 1.07,1.23 and 1.24; 1.16,1.31, respectively). SSC was associated with increased odds of MACCE and mortality (OR 1.52; 1.38,1.68 and 1.81; 1.62,2.02, respectively) but not bleeding or stroke, whereas the RA group was at no increased risk of any complication.Conclusion: In a nationwide cohort of AMI hospitalizations we demonstrate lower utilization of invasive management in patients with SLE and worse outcomes after AMI in SLE and SSC patients compared to those without AIRD.

AB - Objectives: The present study sought to examine national-level differences in management strategies and outcomes in patients with autoimmune rheumatic disease (AIRD) with acute myocardial infarction (AMI) between 2004 and 2014.Methods: All AMI hospitalizations were analyzed from National Inpatient Sample, stratified according to AIRD diagnosis into four 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 (CA) and percutaneous coronary intervention (PCI) and 2) clinical outcomes were examined in comparison to patients without AIRD.Results: Out 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 has risen from 1.0% (2004) to 1.5% (2014) while SLE and SSC remained stable. Patients with SLE were less likely to receive invasive management (odds ratio (OR) CA:0.87; 95% confidence interval (CI) 0.84,0.91, PCI:0.93 0.90,0.96) whereas no statistically significant differences were found in RA and SSC groups. Subsequently, the odds of mortality and bleeding were increased in patients with SLE (OR 1.15; 1.07,1.23 and 1.24; 1.16,1.31, respectively). SSC was associated with increased odds of MACCE and mortality (OR 1.52; 1.38,1.68 and 1.81; 1.62,2.02, respectively) but not bleeding or stroke, whereas the RA group was at no increased risk of any complication.Conclusion: In a nationwide cohort of AMI hospitalizations we demonstrate lower utilization of invasive management in patients with SLE and worse outcomes after AMI in SLE and SSC patients compared to those without AIRD.

KW - acute myocardial infarction

KW - rheumatoid arthritis

KW - systemic sclerosis

KW - systemic lupus erythematosus

KW - outcomes

KW - revascularization

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DO - 10.1016/j.mayocp.2020.04.044

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SN - 0025-6196

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JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

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Acute Myocardial Infarction in Autoimmune Rheumatologic Disease: A Nationwide Analysis of Clinical outcomes and Predictors of Management Strategy

Abstract

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Keywords

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