Anna Södergren1,2, Johan Askling3, Karin Bengtsson4, Helena Forsblad-d'Elia5, Tomas Jernberg6, Ulf Lindström4, Lotta Ljung5,3, Ängla Mantel3, Lennart T H Jacobsson4. 1. Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden. anna.sodergren@umu.se. 2. Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden. anna.sodergren@umu.se. 3. Clinical Epidemiology Section, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 4. Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 5. Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden. 6. Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
Abstract
OBJECTIVES: To study clinical characteristics, mortality, and secondary prevention, after a first incident acute myocardial infarction (AMI) in patients with ankylosing spondylitis (AS) compared with the general population. METHODS: In total, 292 subjects with AS and a first AMI between Jan 2006 and Dec 2014 were identified using the Swedish national patient register. Each subject was matched with up to 5 general population comparators per AS-patient (n = 1276). Follow-up started at the date of admission for AMI and extended until death or 365 days of follow-up. Cox regression was used to assess mortality in two time intervals: days 0-30 and days 31-365. For a subgroup with available data, clinical presentation at admission, course, treatment for AMI, and secondary prevention were compared. RESULTS: During the 365-day follow-up, 56/292 (19%) AS patients and 184/1276 (14%) comparators died. There were no difference in mortality due to cardiovascular-related causes, although the overall mortality day 31-365 was increased among patients with AS compared with comparators (HR [95% CI] = 2.0 [1.3;3.0]). At admission, AS patients had a higher prevalence of cardiovascular comorbidities compared with comparators. At discharge, patients with AS were less often prescribed lipid-lowering drugs and non-aspirin antiplatelet therapy. CONCLUSIONS: Patients with AS tend to have a higher comorbidity burden at admission for first AMI. The mortality after a first AMI due to cardiovascular-related causes does not seem to be elevated, despite an increased overall mortality during days 31-365 among patients with AS compared with the general population. Key Points • The all-cause mortality after a first AMI was higher in patients with AS. • Mortality after a first AMI due to CVD-related causes does not seem to be elevated for patients with AS. • In patients with AS suffering a first AMI, more attention should be given to other comorbidities causing an excess in mortality.
OBJECTIVES: To study clinical characteristics, mortality, and secondary prevention, after a first incident acute myocardial infarction (AMI) in patients with ankylosing spondylitis (AS) compared with the general population. METHODS: In total, 292 subjects with AS and a first AMI between Jan 2006 and Dec 2014 were identified using the Swedish national patient register. Each subject was matched with up to 5 general population comparators per AS-patient (n = 1276). Follow-up started at the date of admission for AMI and extended until death or 365 days of follow-up. Cox regression was used to assess mortality in two time intervals: days 0-30 and days 31-365. For a subgroup with available data, clinical presentation at admission, course, treatment for AMI, and secondary prevention were compared. RESULTS: During the 365-day follow-up, 56/292 (19%) ASpatients and 184/1276 (14%) comparators died. There were no difference in mortality due to cardiovascular-related causes, although the overall mortality day 31-365 was increased among patients with AS compared with comparators (HR [95% CI] = 2.0 [1.3;3.0]). At admission, ASpatients had a higher prevalence of cardiovascular comorbidities compared with comparators. At discharge, patients with AS were less often prescribed lipid-lowering drugs and non-aspirin antiplatelet therapy. CONCLUSIONS:Patients with AS tend to have a higher comorbidity burden at admission for first AMI. The mortality after a first AMI due to cardiovascular-related causes does not seem to be elevated, despite an increased overall mortality during days 31-365 among patients with AS compared with the general population. Key Points • The all-cause mortality after a first AMI was higher in patients with AS. • Mortality after a first AMI due to CVD-related causes does not seem to be elevated for patients with AS. • In patients with AS suffering a first AMI, more attention should be given to other comorbidities causing an excess in mortality.
Authors: Sofia Exarchou; Elisabeth Lie; Ulf Lindström; Johan Askling; Helena Forsblad-d'Elia; Carl Turesson; Lars Erik Kristensen; Lennart Th Jacobsson Journal: Ann Rheum Dis Date: 2015-09-02 Impact factor: 19.103
Authors: Karin Bengtsson; Helena Forsblad-d'Elia; Elisabeth Lie; Eva Klingberg; Mats Dehlin; Sofia Exarchou; Ulf Lindström; Johan Askling; Lennart T H Jacobsson Journal: Arthritis Res Ther Date: 2017-05-18 Impact factor: 5.156