Outcomes of Percutaneous Coronary Intervention in Patients with Rheumatoid Arthritis.

Abstract

RA is the most common inflammatory arthritis and is associated with increased risk of cardiovascular events and mortality. Evidence regarding outcomes following PCI is limited. This study aimed to assess differences in outcomes following percutaneous coronary intervention (PCI) between patients with and without rheumatoid arthritis (RA). The Melbourne Interventional Group PCI registry (2005-2018) was used to identify 756 patients with RA. Outcomes were compared to the remaining cohort (N=38,579). Patients with RA were older, more often female, with higher rates of hypertension, previous stroke, peripheral vascular disease, obstructive sleep apnoea, chronic lung disease, myocardial infarction, and renal impairment, while rates of dyslipidaemia and current smoking were lower, all p<0.05. Lesions in patients with RA were more frequently complex (ACC/AHA type B2/C), requiring longer stents, with higher rates of no reflow, all p<0.05. Risk of long-term mortality, adjusted for potential confounders, was higher for patients with RA (Hazard Ratio 1.53, 95%CI 1.30-1.80; median follow-up 5.0 years), while 30-day outcomes including mortality, major adverse cardiovascular events, bleeding, stroke, myocardial infarction, coronary artery bypass surgery and target vessel revascularisation were similar. In subgroup analysis, patients with RA and lower BMI (Pfor interaction<0.001) and/or acute coronary syndromes (Pfor interaction=0.05) had disproportionately higher risk of long-term mortality compared to patients without RA. In conclusion, patients with RA undergoing PCI had more comorbidities and longer, complex coronary lesions. Risk of short-term adverse outcomes were similar, while risk of long-term mortality was higher, especially among patients with acute coronary syndromes and lower BMI.