Abstract
Background
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.
Methods
A cross-sectional analysis of 1,112,676 patients with myocardial infarction in the
2003-2005 Nationwide Inpatient Sample was performed.
Results
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.
Conclusions
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.
Keywords
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Article info
Footnotes
Funding: This study was supported by the Eskridge Translational Research Award.
Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
