Similar myocardial infarction characteristics and short-term outcomes in patients with and without inflammatory joint diseases: A nationwide Norwegian study

Objectives

To compare presenting symptoms, myocardial damage, acute treatment, in-hospital adverse events, short-term outcomes and secondary cardio-preventive drugs in patients with rheumatoid arthritis, axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) experiencing their first myocardial infarction (MI) versus patients without inflammatory joint diseases (IJD).

Methods

We analyzed register data covering the entire adult Norwegian population, examining individuals experiencing their first MI, sourced from the Norwegian MI register between January 2013 and December 2017. Only patients without known atherosclerotic cardiovascular disease were analyzed. Outcomes were compared between IJD and non-IJD groups using logistic regression and generalized linear models, in age-adjusted models stratified by sex.

Results

Our cohort included 981 RA patients, 314 axSpA patients, 434 PsA patients and 34,783 non-IJD individuals experiencing a first MI. Chest pain was the most common symptom in all groups, and there was no indication that IJD subgroups experienced atypical presentations more often than non-IJD. Myocardial damage indicators – ST-elevation MI rates, troponin T levels and multi-vessel disease – were not worse in IJD patients. Acute treatments were equally, or more, often performed in IJD compared to non-IJD individuals. All in-hospital adverse events and short-term mortality were similar or less common in the IJD subgroups compared to non-IJD patients. None of the secondary cardio-preventive drugs were prescribed less frequently to IJD patients than to non-IJD.

Conclusion

RA, axSpA and PsA patients showed comparable MI presentations, disease courses and short-term outcomes to those without IJD. These findings should provide reassurance about the short-term prognosis of IJD patients experiencing MI.