title: The impact of inflammatory rheumatic diseases on the presentation, severity, and outcome of acute coronary syndrome.
abstract: Patients with inflammatory rheumatic diseases (IRD) have a high burden of cardiovascular disease (CVD), leading to increased mortality and morbidity. However, it is not clear whether increased CVD mortality in IRD is due to a higher incidence or worse outcome of cardiovascular events (higher case fatality). In this observational case-control study, we assessed the outcome of acute coronary syndrome (ACS) in patients with IRDs compared to matched controls without IRD, using data from the Acute Coronary Syndrome Israeli Survey (ACSIS), a large, national, real-life registry detailing the extent, severity, and outcome of ACS. Of 2,193 subjects enrolled to the ACSIS, 20 (nine men) were identified with IRD, including 11 patients with rheumatoid arthritis, five patients with systemic lupus erythematosus (SLE), three patients with ankylosing spondylitis (AS), and one patient with psoriatic arthritis (PsA). The study patients were compared to 120 matched control patients (adjusted for age and risk factors for CVD) without IRD. Compared to controls, IRD patients had similar clinical presentation and similar type of ACS and received identical initial treatment at the ER. The two groups had comparable rates of complications including major adverse cardiovascular events (death, recurrent myocardial infarction, stroke, major bleeding, and definite stent thrombosis) (10 vs. 11.7% in the study and control group, respectively, p > 0.05), re-hospitalization (20 vs. 21.1%, respectively, p > 0.05), and severe congestive heart failure (7.7 vs. 6.9%, respectively, p > 0.05) within 30 days. The outcome and prognosis of ACS in patients with IRD is not worse than that of control, supporting the higher prevalence of CVD in this population as the cause for their excess mortality.
authors.affiliation: Department of Medicine F and the Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel. Ilan.BenZvi@sheba.health.gov.il.|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Ilan.BenZvi@sheba.health.gov.il.|The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012, Chaim Sheba Medical Center, Tel Hashomer, Israel. Ilan.BenZvi@sheba.health.gov.il.
authors.forename: Ilan
authors.initials: I
authors.lastname: Ben-Zvi
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|The Leviev Heart Institute, Sheba Medical Center, Tel Hashomer, Israel.|Neufeld Cardiac Research Institute, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|The Leviev Heart Institute, Sheba Medical Center, Tel Hashomer, Israel.|Neufeld Cardiac Research Institute, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.affiliation: Department of Medicine F and the Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Chagai
authors.initials: C
authors.lastname: Grossman
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Medicine, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel.
authors.forename: Avishay
authors.initials: A
authors.lastname: Elis
authors.affiliation: Neufeld Cardiac Research Institute, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Natalie
authors.initials: N
authors.lastname: Gavrielov-Yusim
authors.affiliation: Department of Medicine F and the Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel.|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Livneh
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D000368:Aged; D015535:Arthritis, Psoriatic / Q000150:complications*; D001172:Arthritis, Rheumatoid / Q000150:complications*; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000150:complications*
keywords: Cardiovascular; Coronary syndrome; Inflammation; Rheumatoid arthritis