RESEARCH - Excess recurrent cardiac events in RA patients with acute coronary syndrome

[Guest guest]

Ann Rheum Dis. 2005 Aug 3; [Epub ahead of print]

Excess Recurrent Cardiac Events in Rheumatoid Arthritis Patients with Acute

Coronary Syndrome.

KM, Pace AV, Treharne GJ, Saratzis A, Nightingale P, Erb N, Banks

MJ, Kitas GD.

Dudley Group of Hospitals, United Kingdom.

OBJECTIVES: Cardiovascular mortality is increased in rheumatoid arthritis

(RA). Possible reasons include increased incidence or prevalence of

ischaemic heart disease (IHD) but also worse outcome of IHD, particularly

after an acute coronary syndrome (ACS). We assessed the outcome of ACS in RA

compared to case- matched controls in the context of underlying cardiac risk

factors, clinical presentation and subsequent management. METHODS: 40

patients with RA and ACS identified from coronary care admission registers

between 1990 and 2000 were case-matched as closely as possible for age, sex,

classical cardiovascular risk factors, type and severity of ACS and

admission date (+/- 3 months) with 40 controls. A standardised proforma was

used for detailed case-note review. RESULTS: Age, sex, other cardiovascular

risk factors, type and severity of presenting ACS were not significantly

different between cases and controls. Recurrent cardiac events were commoner

in RA (23/40, 57.5%) than controls (12/40, 30%) (p=0.013); there were 16/40

(40%) deaths in RA versus 6/40 (15%) in controls (p=0.012). Recurrent events

occurred earlier in RA (log rank survival p=0.05). Presentation with chest

pain occurred in all controls compared with 33/40 (82%) of RA patients

(p=0.006); collapse occurred in 1 control (2.5%) versus 7/40 (17.5%) of RA

patients (p=0.025). Treatment during the ACS was not significantly different

in the two groups.

CONCLUSION: Recurrent ischaemic events and death occur more frequently after

ACS in RA. Atypical presentation is commoner in RA. There is an urgent need

to develop identification and intervention strategies for ACS specific to

this high-risk group.

PMID: 16079169

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6079169 & dopt=Abstract

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org