Journal article
Outcomes in Patients with Rheumatoid Arthritis and Myocardial Infarction
The American journal of medicine, Vol.123(10), pp.922-928
2010
DOI: 10.1016/j.amjmed.2010.05.017
PMID: 20920694
Abstract
Patients with rheumatoid arthritis have an increased risk for accelerated atherosclerosis. It is unknown, however, whether rheumatoid arthritis also increases in-hospital mortality after a myocardial infarction or influences the therapy patients receive.
A cross-sectional analysis of 1,112,676 patients with myocardial infarction in the 2003-2005 Nationwide Inpatient Sample was performed.
Patients with rheumatoid arthritis were 39% more likely to receive medical therapy (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.30-1.49) than interventional therapy. By using logistic regression, we adjusted for confounding variables to determine the effect of rheumatoid arthritis on the selection of therapy and found that rheumatoid arthritis itself was associated with a 38% increased likelihood of undergoing thrombolysis (OR, 1.38; 95% CI, 1.10-1.71) and a 27% increased likelihood of undergoing percutaneous coronary intervention (OR, 1.27; 95% CI, 1.17-1.39). For the primary outcome measure, we determined that patients with rheumatoid arthritis overall had a 24% better in-hospital mortality compared with other patients with a myocardial infarction (OR, 0.76; 95% CI, 0.68-0.86), which was 34% better after adjusting for confounding variables (OR, 0.66; 95% CI, 0.59-0.74). This better in-hospital mortality was seen in patients with rheumatoid arthritis undergoing medical therapy (adjusted OR, 0.67; 95% CI, 0.59-0.75) and percutaneous coronary intervention (adjusted OR, 0.47; 95% CI, 0.32-0.70), but not in patients undergoing thrombolysis or coronary artery bypass grafting.
Among patients with myocardial infarction, rheumatoid arthritis was associated with an increased use of thrombolysis and percutaneous coronary intervention. Moreover, patients with rheumatoid arthritis had an in-hospital survival advantage, particularly those undergoing medical therapy and percutaneous coronary intervention.
Details
- Title: Subtitle
- Outcomes in Patients with Rheumatoid Arthritis and Myocardial Infarction
- Creators
- Mark L Francis - Division of Rheumatology at Southern Illinois University School of Medicine, SpringfieldJoji J Varghese - Department of Medicine at Southern Illinois University School of Medicine, SpringfieldJacob M Mathew - Department of Medicine at Southern Illinois University School of Medicine, SpringfieldSushma Koneru - Department of Medicine at Southern Illinois University School of Medicine, SpringfieldSteven L Scaife - Division of Rheumatology at Southern Illinois University School of Medicine, SpringfieldWhitney E Zahnd - Division of Rheumatology at Southern Illinois University School of Medicine, Springfield
- Resource Type
- Journal article
- Publication Details
- The American journal of medicine, Vol.123(10), pp.922-928
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.amjmed.2010.05.017
- PMID
- 20920694
- ISSN
- 0002-9343
- eISSN
- 1555-7162
- Grant note
- Eskridge Translational Research Award
- Language
- English
- Date published
- 2010
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984214831402771
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