Abstract
BackgroundRheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction (MI) and post-MI fatality compared with the general population. In a previous study examining post-MI treatment in RA compared with controls we noted that a higher proportion of the RA patients had experienced MI following a surgical procedure. The aim of this study was to compare the risk of MI and mortality at 6 weeks and 12 months following joint surgery in patients with RA compared with the general population.MethodsIndividuals who had undergone joint surgery in Victoria, Australia between 1 July 2000 and 30 June 2007 were identified from routinely collected hospital administrative data. Logistic regression analysis was performed to examine odds of 6 week and 12 month MI and mortality in RA versus non-RA patients with adjustment for age, sex, comorbidities, socioeconomic status, patient type and admission type. Subgroup analysis of total hip and knee arthroplasty episodes was undertaken.ResultsA total of 308,589 episodes of joint surgery occurred among 240,571 individuals, with 3654 (1.2 %) occurring among patients with RA. At 6 weeks post joint surgery the adjusted odds ratio (OR) for MI was 1.50 (95 % CI 0.96–2.33), all-cause death was 1.85 (95 % CI 1.09–3.13) and cardiovascular death was 1.90 (95 % CI 1.07–3.37). At 12 months post joint surgery the adjusted OR of MI was 1.70 (95 % CI 1.27–2.28), all-cause death was 2.18 (95 % CI 1.66–2.86) and cardiovascular death was 2.30 (95 % CI 1.65–3.22). On analysis of joint surgeries other than hip or knee arthroplasty, people with RA were at greater risk of MI within 6 weeks (adjusted OR 2.32; 95 % CI 1.24–4.34) and 12 months (adjusted OR 2.20; 95 % CI 1.47–3.30) compared to those without RA, but no difference in odds of short term mortality were found.ConclusionsFollowing an episode of joint surgery RA patients have a significantly increased risk of death at 6 weeks, and MI and death at 12 months, compared to the general population. The reasons for this remain to be elucidated but in the meantime RA patients should be considered at higher risk in the perioperative period.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-0958-5) contains supplementary material, which is available to authorized users.
Highlights
Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction (MI) and post-MI fatality compared with the general population
Data sources In the Australian state of Victoria, data pertaining to all hospital admissions are collected within the Victorian Admitted Episodes Dataset (VAED), which is maintained by the Victorian Department of Health and Human Services
During the study period 240,571 individuals underwent a total of 308,589 joint surgery procedures, of which 3,654 (1.2 %) were performed on 2,219 people (0.92 %) with RA
Summary
Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction (MI) and post-MI fatality compared with the general population. In almost a third of the RA patients who had MI, the MI had been preceded and possibly precipitated by a medical or a surgical insult This led us to postulate that patients with RA might have an increased burden of silent cardiovascular disease, which is uncovered by a period of physiologic stress. To examine this further we wished to measure the risk of MI and other adverse cardiovascular outcomes in patients with RA compared to the general population following some form of physiologic insult.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
