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Increased Risk of Cardiovascular Events After Coronary Interventions in Inflammatory Bowel Disease: A Nationwide
Ramin Ebrahimi1, Fahim Ebrahimi2,3, Jan Hendrik Niess3,4
1Division of Cardiology, Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
Insights
Patients with inflammatory bowel diseases (IBD) face a 37% higher risk of major adverse cardiovascular events (MACE) after coronary interventions. This highlights the need for proactive cardiovascular risk management in IBD patients.
Area of Science:
- Cardiology
- Gastroenterology
- Public Health
Background:
- Inflammatory bowel diseases (IBD) are linked to increased long-term coronary artery disease (CAD) risk due to chronic systemic inflammation.
- Understanding cardiovascular risk in IBD patients undergoing interventions is crucial.
Purpose of the Study:
- To assess the risk of major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
- To compare cardiovascular outcomes in patients with and without IBD after coronary procedures.
Main Methods:
- Nationwide cohort study (2012-2022) including adults undergoing PCI or CABG.
- Propensity score matching (1:10) of IBD patients to non-IBD comparators.
- Primary outcome: MACE (composite of myocardial infarction, stroke, heart failure hospitalization, mortality). Cox proportional hazards modeling used.
Main Results:
- 987 IBD patients and 9571 comparators included; median follow-up 3.5 years.
- MACE occurred in 49.4% of IBD patients vs. 40.3% of comparators (HR 1.37).
- Increased risk for all MACE components except stroke; no differences by IBD subtype or intervention type.
Conclusions:
- Patients with IBD have a significantly higher risk (37%) of MACE post-coronary intervention.
- Intensified cardiovascular risk reduction strategies are essential for IBD patients undergoing these procedures.
Background:
Inflammatory bowel diseases (IBD) have been associated with an increased long-term risk of coronary artery disease due to chronic systemic inflammation.
Aim:
To evaluate the risk of major adverse cardiovascular events (MACE) after coronary interventions.
Methods:
In this nationwide cohort study of adults undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) (2012-2022), patients with IBD were propensity score-matched 1:10 to comparators without IBD. The primary outcome was MACE, a composite of acute myocardial infarction, stroke, hospitalisation for heart failure, or mortality. Secondary outcomes included each MACE component, 30-day all-cause readmission, revascularisation and in-hospital outcomes including intensive care unit admission and length of hospital stay. We calculated hazard ratios (HRs) and incidence rates (IRs) using Cox proportional hazards modelling.
Results:
We included 987 patients with IBD and 9571 matched comparators. After a median follow-up of 3.5 years, MACE occurred in 488 patients with IBD (49.4%, IR: 96.5/10,000 person-years [PY]) and in 3857 matched comparators (40.3%, IR: 68.9/10,000 PY); HR 1.37 (95% CI, 1.24-1.52). This equates to one additional MACE for every 36 patients with IBD over 10 years. The risk of each MACE component was increased, except for stroke. There were no differences between IBD subtypes or coronary intervention (PCI vs. CABG). Risks were highest in older individuals and elective interventions.
Conclusions:
Patients with IBD were at 37% higher risk of MACE after coronary intervention, indicating a need for intensified cardiovascular risk reduction in these high-risk individuals.
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