Abstract
ObjectivesTo study clinical characteristics, mortality, and secondary prevention, after a first incident acute myocardial infarction (AMI) in patients with ankylosing spondylitis (AS) compared with the general population.MethodsIn total, 292 subjects with AS and a first AMI between Jan 2006 and Dec 2014 were identified using the Swedish national patient register. Each subject was matched with up to 5 general population comparators per AS-patient (n = 1276). Follow-up started at the date of admission for AMI and extended until death or 365 days of follow-up. Cox regression was used to assess mortality in two time intervals: days 0–30 and days 31–365. For a subgroup with available data, clinical presentation at admission, course, treatment for AMI, and secondary prevention were compared.ResultsDuring the 365-day follow-up, 56/292 (19%) AS patients and 184/1276 (14%) comparators died. There were no difference in mortality due to cardiovascular-related causes, although the overall mortality day 31–365 was increased among patients with AS compared with comparators (HR [95% CI] = 2.0 [1.3;3.0]). At admission, AS patients had a higher prevalence of cardiovascular comorbidities compared with comparators. At discharge, patients with AS were less often prescribed lipid-lowering drugs and non-aspirin antiplatelet therapy.ConclusionsPatients with AS tend to have a higher comorbidity burden at admission for first AMI. The mortality after a first AMI due to cardiovascular-related causes does not seem to be elevated, despite an increased overall mortality during days 31–365 among patients with AS compared with the general population.Key Points• The all-cause mortality after a first AMI was higher in patients with AS.• Mortality after a first AMI due to CVD-related causes does not seem to be elevated for patients with AS.• In patients with AS suffering a first AMI, more attention should be given to other comorbidities causing an excess in mortality.
Highlights
Data sourcesAnkylosing spondylitis (AS) is a chronic, inflammatory disease, primarily involving the spine as well as peripheral joints and entheses [1]
Since ankylosing spondylitis (AS) affects the entheses of the thorax, chest pain is common among these patients as part of the rheumatic disease, which could result in an atypical clinical presentation that may be misinterpreted by both patients and caregivers [12]
No statistically significant differences in body mass index (BMI) or smoking habits were observed for AS compared with population comparators, but most of the analysed comorbidities were more common in the patients with AS (Table 1)
Summary
Ankylosing spondylitis (AS) is a chronic, inflammatory disease, primarily involving the spine as well as peripheral joints and entheses [1]. Recent studies have shown that patients with AS have an increased risk of atherosclerotic comorbidity such as acute myocardial infarction (AMI) and stroke compared with the general population [3,4,5]. Patients with AS have a higher both overall and cardiovascular disease (CVD)–related mortality compared with the general population [6, 7]. There are indications that patients with chronic inflammatory diseases might have an altered outcome after an CVD event [3, 10, 11]. The course and pattern of AMI in AS patients compared with general population controls have not previously been studied systematically
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