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Treatment and Outcomes of Acute Myocardial Infarction in Patients With Polymyalgia Rheumatica With and Without Giant Cell Arteritis.

Sokhal, BS; Matetić, A; Bharadwaj, A; Helliwell, T; Abhishek, A; Mallen, C; Mohamed, MO; Mamas, M

Treatment and Outcomes of Acute Myocardial Infarction in Patients With Polymyalgia Rheumatica With and Without Giant Cell Arteritis. Thumbnail


Authors

BS Sokhal

A Matetić

A Bharadwaj

A Abhishek

MO Mohamed



Abstract

This study analyzed the characteristics, management, and outcomes of patients with polymyalgia rheumatica (PMR) hospitalized with acute myocardial infarction (AMI), including sensitivity analysis for presence of giant cell arteritis (GCA). Using the National Inpatient Sample (January 2004 to September 2015) and International Classification of Diseases, Ninth Revision, all AMI hospitalizations were stratified into main groups: PMR and no-PMR; and subsequently, PMR, PMR with GCA, and GCA and no-PMR. Outcomes were all-cause mortality, major adverse cardiovascular/cerebrovascular events (MACCEs), major bleeding, and ischemic stroke as well as coronary angiography (CA) and percutaneous coronary intervention (PCI). Multivariable logistic regression was used to determine adjusted odds ratios with 95% confidence interval (95% CI). A total of 7,622,043 AMI hospitalizations were identified, including 22,597 patients with PMR (0.3%) and 5,405 patients with GCA (0.1%). Patients with PMR had higher rates of mortality (5.8% vs 5.4%, p = 0.013), MACCEs (10.2% vs 9.2%, p <0.001), and stroke (4.6% vs 3.5%, p <0.001) and lower receipt of CA (48.9% vs 62.6%, p <0.001) and PCI (30.6% vs 41.0%, p <0.001) than the no-PMR group. After multivariable adjustment, patients with PMR had decreased odds of mortality (0.75, 95% CI 0.71 to 0.80), MACCEs (0.78, 95% CI 0.74 to 0.81), bleeding (0.79, 95% CI 0.73 to 0.86), and stroke (0.88, 95% CI 0.83 to 0.93); no difference in use of CA (1.01, 95% CI 0.98 to 1.04) and increased odds of PCI (1.07 95% CI 1.03 to 1.10) compared with the no-PMR group. Similar results were observed for patients with concomitant PMR and GCA, whereas patients with GCA only showed increased odds of bleeding (1.51 95% CI 1.32 to 1.72) and stroke (1.31 95% CI 1.16 to 1.47). In conclusion, patients with AMI with PMR have an increased incidence of crude adverse in-hospital outcomes than those without PMR; however, these differences do not persist after adjusting for age and comorbidities.

Acceptance Date Mar 9, 2022
Publication Date Apr 23, 2022
Publicly Available Date Jun 20, 2023
Journal American Journal of Cardiology
Print ISSN 0002-9149
Publisher Elsevier
Pages 12-19
DOI https://doi.org/10.1016/j.amjcard.2022.03.034
Publisher URL https://www.ajconline.org/article/S0002-9149(22)00327-7/fulltext