Outcomes of Acute Myocardial Infarction in Patients with Rheumatoid Arthritis

Am J Med. 2020 Oct;133(10):1168-1179.e4. doi: 10.1016/j.amjmed.2020.02.039. Epub 2020 Apr 10.

Abstract

Background: There is a paucity of data on the outcomes of acute myocardial infarction in patients with rheumatoid arthritis in the contemporary era.

Methods: We queried the National Inpatient Sample database (2002-2016) for hospitalizations with acute myocardial infarction. We described the trends and outcomes of acute myocardial infarction-rheumatoid arthritis compared with acute myocardial infarction-no rheumatoid arthritis.

Results: The analysis included 9,359,546 hospitalizations with acute myocardial infarction, of whom 123,783 (1.3%) had rheumatoid arthritis. There was an increase in the number of hospitalizations with acute myocardial infarction-rheumatoid arthritis (Ptrend < .001). There was an observed downtrend in mortality rates for acute myocardial infarction-rheumatoid arthritis (5.8% in 2002 vs 5.2% in 2016, Ptrend = .01) corresponding to an increase in the utilization of percutaneous coronary intervention (Ptrend < .001). In the overall cohort of acute myocardial infarction, rheumatoid arthritis was independently associated with lower rate of in-hospital mortality (adjusted odds ratio 0.90; 95% confidence interval, 0.81-0.99, P = .03). Compared with ST-elevation myocardial infarction (STEMI)-no rheumatoid arthritis, STEMI-rheumatoid arthritis was associated with lower in-hospital mortality and cardiac arrest, while it was associated with higher discharges to nursing facilities. No difference in mortality was observed among non-ST-elevation myocardial infarction (NSTEMI)-rheumatoid arthritis and NSTEMI-no rheumatoid arthritis, while NSTEMI-rheumatoid arthritis was associated with lower cardiac arrest, cardiogenic shock, and hemodialysis, at the expense of higher bleeding events and discharges to nursing facilities.

Conclusion: In this nationwide analysis, we found an increase in hospitalizations for acute myocardial infarction-rheumatoid arthritis. Among patients with acute myocardial infarction, rheumatoid arthritis was independently associated with lower in-hospital mortality, particularly in cases of STEMI.

Keywords: Acute myocardial infarction; Non-ST-elevation myocardial infarction; Rheumatoid arthritis; ST-elevation myocardial infarction.

MeSH terms

  • Acute Kidney Injury / epidemiology
  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid / epidemiology*
  • Assisted Circulation
  • Blood Coagulation Disorders / epidemiology
  • Blood Transfusion / statistics & numerical data
  • Chronic Disease
  • Comorbidity
  • Coronary Artery Bypass / statistics & numerical data
  • Coronary Artery Bypass / trends
  • Female
  • Heart Arrest / epidemiology
  • Heart Arrest / etiology
  • Hemorrhage / epidemiology
  • Hemorrhage / therapy
  • Hospital Mortality / trends*
  • Hospitalization
  • Humans
  • Lung Diseases
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy
  • Non-ST Elevated Myocardial Infarction / complications
  • Non-ST Elevated Myocardial Infarction / mortality
  • Non-ST Elevated Myocardial Infarction / therapy*
  • Patient Discharge
  • Percutaneous Coronary Intervention / statistics & numerical data
  • Percutaneous Coronary Intervention / trends
  • Renal Dialysis / statistics & numerical data
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / therapy
  • ST Elevation Myocardial Infarction / complications
  • ST Elevation Myocardial Infarction / mortality
  • ST Elevation Myocardial Infarction / therapy*
  • Shock, Cardiogenic / epidemiology
  • Shock, Cardiogenic / etiology
  • Skilled Nursing Facilities / statistics & numerical data
  • United States / epidemiology