Patients with rheumatoid arthritis (RA) who experience an acute myocardial infarction (MI) are significantly less likely than controls to be given acute reperfusion, a retrospective Australian study showed.
In a structured chart review from three hospitals in the city of Victoria, only 16% of the RA patients received acute reperfusion compared with 37% of the matched controls (OR 0.27, 95% CI 0.10 to 0.64), according to Sharon Van Doornum, MD, of the University of Melbourne, and colleagues.
This may help explain the higher mortality rate associated with MI among RA patients, the investigators wrote online in Arthritis Research & Therapy.
Van Doornum's group had previously found an adjusted odds ratio for 30-day post-MI mortality in patients with rheumatoid arthritis of 1.9 (95% CI 1.3 to 2.7).
Reasons for the almost twofold increased mortality risk seen in a prior study from the same investigators were uncertain, but the researchers speculated that the higher case fatality in RA patients could stem from "possible delays in seeking medical attention or in diagnosis, or different patterns of coronary disease in RA."
Another possibility, the researchers suggested, could be differences in treatment after the acute cardiac event, such as in use of thrombolysis or percutaneous coronary intervention (PCI) and secondary pharmacoprevention.
http://www.medpagetoday.com/Rheumatology/Arthritis/22698