MI patients with rheumatoid arthritis face grim outlook

Results of a recent study paint a grim picture for the long-term outcomes of myocardial infarction (MI) patients with rheumatoid arthritis (RA), with RA duration and corticosteroid usage and dosage independently predicting mortality.

The analysis included 1,614 real-life MI patients with RA (mean age, 74 years) and 8,070 propensity-score matched MI patients without RA. Most RA patients (80.9 percent) were seropositive.

In the RA cohort, median length of hospital stay after MI was 7 days, while the median RA duration before the index event was 14.4 years. There were 48.5 percent of patients using oral corticosteroids, 34.3 percent methotrexate, and 3.0 percent biological drugs within 180 days before MI. The median average corticosteroid dosage was 4.1 mg/day among users.

Over a median follow-up of 7.3 years, 5,468 deaths occurred, including 1,016 in the RA cohort. Multivariable Cox analysis showed that RA contributed to an increased 14-year mortality risk after MI RA (80.4 percent vs 72.3 percent; hazard ratio [HR], 1.25, 95 percent confidence interval [CI], 1.16–1.35; p<0.0001).

Patients with versus without RA were also at higher risk of new MI (HR, 1.22, 95 percent CI, 1.09–1.36; p=0.0001) and revascularization (HR, 1.28, 95 percent CI, 1.10–1.49; p=0.002) after discharge from index MI. There was no between-group difference in cumulative stroke rate after MI (p=0.322).

RA duration and corticosteroid usage before MI, but not use of methotrexate or biologic antirheumatic drugs, were strongly associated with elevated risks of death (p<0.001) and new MI (p=0.009). A higher dosage of corticosteroids prior to MI was also linked to higher long-term mortality (p=0.002) and methotrexate usage with lower stroke rate (p=0.034). Serological status of RA was not associated with outcomes.

The findings underscore a need for MI patients with RA to undergo a comprehensive evaluation and optimization of treatment to improve long-term outcomes.