Outcomes of percutaneous coronary intervention among patients with rheumatoid arthritis.

Abstract

Background: Rheumatoid arthritis (RA) is the most common inflammatory arthritis and is associated with increased risk of cardiovascular events and mortality. Data regarding long-term percutaneous coronary intervention (PCI) outcomes are limited. Methods: The Melbourne Interventional Group PCI registry (2005-2018) was used to identify 756 patients with RA and outcomes were compared to the remaining cohort (N=38,579). Cox regression analysis was performed to assess risk of adverse events. Results: Patients with RA were older and more often female, with higher rates of hypertension, previous stroke, peripheral vascular disease, obstructive sleep apnoea, chronic lung disease, prior myocardial infarction, and poor renal function, while rates of current smoking were lower, all p<0.05. Lesions were more frequently complex (ACC/AHA type B2/C), required longer stents, and rates of no reflow were higher, all p<0.05. Mortality at 30-days was higher (4.4% vs 3.3%, p=0.04) mainly relating to higher non-cardiac mortality (1.6% vs 0.8%, p=0.01). Risk of long-term mortality was higher for RA patients (28% vs 19%, mean follow-up 5.4 years, Hazard Ratio [HR] 1.44, 95% CI 1.25-1.67 adjusted for age, sex and comorbidities) and varied by PCI indication subtype (STEMI HR 1.38, 95% CI 1.06-1.81; NSTEACS HR 1.86, 95% CI 1.49-2.34; non-ACS HR 1.09, 95% CI 0.75-1.59). Risk of 30-day mortality, MACE, bleeding, and target lesion revascularisation were similar. Conclusions: Patients with RA undergoing PCI have more comorbidities and longer, more complex coronary lesions. Risk of short-term adverse outcomes are similar, while risk of long-term mortality is higher, especially among patients with acute coronary syndromes.