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Long-term outcomes after coronary artery bypass surgery in patients with rheumatoid arthritis

Markus Malmberg1, Antti Palomäki2,3,4, Jussi O T Sipilä5,6

  • 1Heart Center, Turku University Hospital and University of Turku, Turku, Finland.

Annals of Medicine
|August 31, 2021
PubMed

Insights

Patients with rheumatoid arthritis (RA) face worse long-term outcomes after coronary artery bypass grafting (CABG). Preoperative corticosteroid use and longer RA duration increase mortality risk following CABG surgery.

Area of Science:

  • Cardiology
  • Rheumatology
  • Surgical Outcomes

Background:

  • Rheumatoid arthritis (RA) is a systemic autoimmune disease that can affect cardiovascular health.
  • Coronary artery bypass grafting (CABG) is a common surgical intervention for severe coronary artery disease.

Purpose of the Study:

  • To investigate the long-term prognosis of patients with rheumatoid arthritis (RA) undergoing coronary artery bypass grafting (CABG).
  • To identify specific factors in RA patients that may influence outcomes after CABG.

Main Methods:

  • A multicentre, population-based cohort study in Finland compared 378 RA patients with 7560 non-RA patients who underwent CABG.
  • Propensity score-matching was used to adjust for baseline differences.
  • Median follow-up was 9.7 years.

Main Results:

  • RA diagnosis was associated with significantly increased mortality (HR 1.50) and myocardial infarction risk (HR 1.61) after CABG.
  • Longer RA duration and preoperative corticosteroid use were independently linked to higher mortality.
  • No differences were observed in 30-day mortality or cardiovascular medication use.

Conclusions:

  • Rheumatoid arthritis is an independent predictor of worse long-term outcomes following CABG.
  • Preoperative corticosteroid use and extended RA disease duration are critical risk factors for mortality post-CABG.
  • Enhanced secondary cardiovascular disease prevention strategies are crucial for RA patients post-CABG.
Abstract

Keywords:
Case-control studycoronary artery bypass grafting surgerycoronary artery diseaseoutcomesrheumatoid arthritis

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