Outcomes of Acute Myocardial Infarction in Patients with Rheumatoid Arthritis

BACKGROUND:

There is 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 a rise in the number of hospitalizations with acute myocardial infarction-rheumatoid arthritis (Ptrend<0.001). There was an observed downtrend in mortality rates for acute myocardial infarction-rheumatoid arthritis (5.8% in 2002 versus 5.2% in 2016, Ptrend=0.01) corresponding to a rise in the utilization of percutaneous coronary intervention (Ptrend<0.001). 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%CI: 0.81-0.99, p=0.03). 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 facility. 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.