Acute Myocardial Infarction in Autoimmune Rheumatological 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 journalArticle

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 languageEnglish
JournalMayo Clinic Proceedings
Publication statusAccepted/In press - 14 Apr 2020

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Keywords

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

Cite this

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. (Accepted/In press). Acute Myocardial Infarction in Autoimmune Rheumatological Disease: A Nationwide Analysis of Clinical outcomes and Predictors of Management Strategy. Mayo Clinic Proceedings.