3 research outputs found
Outcomes Following Acute Coronary Syndrome in Patients With and Without Rheumatic ImmuneâMediated Inflammatory Diseases
Background Rheumatic immune mediated inflammatory diseases (IMIDs) are associated with high risk of acute coronary syndrome. The longâterm prognosis of acute coronary syndrome in patients with rheumatic IMIDs is not well studied. Methods and Results We identified Medicare beneficiaries admitted with a primary diagnosis of myocardial infarction (MI) from 2014 to 2019. Outcomes of patients with MI and concomitant rheumatic IMIDs including systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, dermatomyositis, or psoriasis were compared with propensity matched control patients without rheumatic IMIDs. Oneâtoâthree propensityâscore matching was done for exact age, sex, race, STâsegmentâelevation MI, and nonâSTâsegmentâelevation MI variables and greedy approach on other comorbidities. The study primary outcome was allâcause mortality. The study cohort included 1â654â862 patients with 3.6% prevalence of rheumatic IMIDs, the most common of which was rheumatoid arthritis, followed by systemic lupus erythematosus. Patients with rheumatic IMIDs were younger, more likely to be women, and more likely to present with nonâSTâsegmentâelevation MI. Patients with rheumatic IMIDs were less likely to undergo coronary angiography, percutaneous coronary intervention or coronary artery bypass grafting. After propensityâscore matching, at median follow up of 24 months (interquartile range 9â45), the risk of mortality (adjusted hazard ratio [HR], 1.15 [95% CI, 1.14â1.17]), heart failure (HR, 1.12 [95% CI 1.09â1.14]), recurrent MI (HR, 1.08 [95% CI 1.06â1.11]), and coronary reintervention (HR, 1.06 [95% CI, 1.01â1.13]) (P<0.05 for all) was higher in patients with versus without rheumatic IMIDs. Conclusions Patients with MI and rheumatic IMIDs have higher risk of mortality, heart failure, recurrent MI, and need for coronary reintervention during followâup compared with patients without rheumatic IMIDs