Abstract 19598: Increased Risk of Repeat Coronary Revascularization is Reduced by Methotrexate or Tumor Necrosis Factor Inhibitor Treatments in Patients With Rheumatoid Arthritis
Background: Rheumatoid arthritis (RA) is a chronic inflammatory condition associated with an increased risk of atherosclerosis and cardiovascular mortality. Long term data on outcomes after percutaneous coronary intervention (PCI) is lacking in this population, specifically with regards to repeat revascularization. We investigated target lesion(TLR) and target vessel revascularization(TVR) in this population.
Methods: We performed a single center retrospective case control study of RA patients post PCI. Each treated RA lesion was matched to 3 control lesions based upon procedure date, drug eluting stent use, age, vein graft intervention and diabetes mellitus. Patients were censored following the last encounter in the medical record. Primary endpoints were time to TLR and TVR. Kaplan-Meier analyses and shared frailty Cox proportional hazards models were performed to compare event free survival.
Results: A total of 228 lesions (142 patients) were identified in the RA cohort and matched to 677 control lesions (540 patients). Both groups were followed for a mean of 3.8 years with no difference in repeat catheterizations. There was a trend towards more TLR (HR 1.32; 95% CI 0.97-1.80) and TVR (HR 1.15; 95% CI 0.82-1.62) in RA patients. In the RA group, patients treated with methotrexate or TNF inhibitors showed significantly less TVR (figure 1). This continued to be significant when adjusting for baseline procedural differences (adjusted HR 0.52, 95% CI 0.28-0.98). TLR was also significantly reduced (unadjusted HR 0.46; 95% CI 0.23-0.92) but failed to meet significance after adjustment (adjusted HR 0.69; 95% CI 0.37-1.28).
Conclusions: RA, a chronic inflammatory condition, may put patients at risk for repeat revascularization after coronary stenting. This risk appears to be reduced by treatment with anti-inflammatory agents. This has implications for the management of RA patients post PCI and may have applicability to other inflammatory diseases such as diabetes.
Author Disclosures: M. Sintek: None. C. Sparrow: None. E. Novak: None. J. Singh: Honoraria; Modest; Medicine’s Company, Medtronic, St. Jude, Volcano. Consultant/Advisory Board; Modest; Abott Vascular, Volcano, Boston Scientific.
- © 2014 by American Heart Association, Inc.