Prognostic impact of chronic inflammatory diseases in patients with ST-segmentelevation myocardial infarction

Abstract

Chronic inflammatory diseases (CID) are common and affect 5 to 7% of the general population. In primary prevention the presence of CID increases the risk of cardiovascular disease (e.g. ST-segment elevation myocardial infarction or STEMI), but the prognosis after the occurrence of STEMI in these patients is poorly studied. The objective of our study is to determine the prognostic impact related to the presence of a MIC on mortality in patients with STEMI. Single-centre cohort including patients managed at the University Hospital of Limoges for STEMI from June 2011 to May 2019 and included in the SCALIM registry. The presence of any MIC defined the CID+ group, compared to other patients (CID-). The primary endpoint was mortality. Secondary endpoints included cardiovascular mortality, recurrent coronary events, new cardiac hospitalizations, occurrence of acute peripheral arterial events and ischemic stroke, and all of those combined. Our study included 1941 patients aged 65 ± 14 years, 75% of whom were men. The prevalence of CID in the SCALIM registry was 4.6% (including 22% rhumatoid arthritis, 19% psoriasis and 16% ankylosing spondylitis) and 40% were on corticosteroid therapy and 20% on biotherapy at STEMI. Over a mean follow-up of 3.4 ± 2.6 years after STEMI, we found no significant difference in mortality in the CID+ and CID- groups respectively (22.5% vs. 15.9% P = 0.14) or in the combined secondary endpoint (29% vs. 49% P = 0.11). Long-term corticosteroid therapy was associated with excess mortality in the CID+ group (39% vs. 12%, P < 0.01). Despite the cardiovascular excess risk described in the literature related to the presence of a MIC, we did not show mortality excess related to these conditions after a STEMI. The mortality risk excess in patients under corticosteroids suggests a multidisciplinary discussion on their management. Further analysis is needed to confirm our results.