Long-term clinical outcomes of patients with rheumatoid arthritis and concomitant coronary artery disease.
BACKGROUND
Rheumatoid arthritis (RA) is associated with high morbidity and mortality predominately due to increased cardiovascular risk. Few reports are available regarding the management of coronary artery disease (CAD) in RA patients and the long-term clinical outcomes after coronary revascularization.


RESULTS
All consecutive patients with RA were identified by retrospective review at a rheumatology tertiary center in Milan, Italy between 2001 and 2013. RA patients affected by significant CAD (RA-CAD+) were prospectively followed for major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary revascularization (RA-PCI), coronary artery bypass grafting (RA-CABG) or medical therapy (RA-MT). Among 936 patients with RA, the presence of clinically significant CAD was found in 5.6% (53 patients, RA-CAD+). Of these, 32 patients (60%) underwent PCI (RA-PCI), 10 patients (19%) underwent CABG (RA-CABG) and 11 patients (21%) treated with MT (RA-MT). After a mean follow-up of 9±7 years, the rate of MACCE was 56% in RA-PCI patients, 50% in RA-CABG and 27% in RA-MT patients (P=0.184). The high MACCE rate was mainly driven by repeat coronary revascularization (47%) in the RA-PCI group and high rate of strokes (30%) in RA-CABG patients.


CONCLUSIONS
In patients with rheumatoid arthritis and concomitant coronary artery disease (RA-CAD+), we observed at long-term follow-up a high MACCE rate, predominantly in those who underwent coronary revascularization.
Department of Cardiovascular, San Raffaele Scientific Institute Milan, Italy.
Marco
M
Spartera
Department of Cardiovascular, San Raffaele Scientific Institute Milan, Italy.
Cosmo
C
Godino
Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific Institute Milan, Italy.
Elena
E
Baldissera
Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific Institute Milan, Italy.
Corrado
C
Campochiaro
Department of Cardiovascular, San Raffaele Scientific Institute Milan, Italy.
Ketty
K
La Spina
Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific Institute Milan, Italy.
Patrizia
P
Aiello
Department of Cardiovascular, San Raffaele Scientific Institute Milan, Italy.
Anna
A
Salerno
Department of Cardiovascular, San Raffaele Scientific Institute Milan, Italy.
Michela
M
Cera
Department of Cardiovascular, San Raffaele Scientific Institute Milan, Italy.
Valeria
V
Magni
Imperial College London London, UK.
Richard J
RJ
Jabbour
Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific Institute Milan, Italy.
Lorenzo
L
Dagna
Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific Institute Milan, Italy.
Moreno
M
Tresoldi
Department of Cardiovascular, San Raffaele Scientific Institute Milan, Italy.
Alberto
A
Cappelletti
Department of Cardiovascular, San Raffaele Scientific Institute Milan, Italy.
Ottavio
O
Alfieri
Department of Cardiovascular, San Raffaele Scientific InstituteMilan, Italy; EMO-GVM Centro Cuore ColumbusMilan, Italy.
Antonio
A
Colombo
Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific Institute Milan, Italy.
Maria Grazia
MG
Sabbadini
Department of Cardiovascular, San Raffaele Scientific Institute Milan, Italy.
Alberto
A
Margonato
Coronary artery disease; coronary artery bypass grafting; percutaneous coronary intervention; rheumatoid arthritis