Sintek Marc A, Sparrow Christopher T, Mikuls Ted R, Lindley Kathryn J, Bach Richard G, Kurz Howard I, Novak Eric, Singh Jasvindar
Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA.
Division of Rheumatology, University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA.
Heart. 2016 Mar;102(5):363-9. doi: 10.1136/heartjnl-2015-308634. Epub 2015 Dec 30.
To investigate repeat revascularisation outcomes in patients with rheumatoid arthritis(RA) after percutaneous coronary intervention (PCI).
We performed a single-centre, retrospective matched cohort study of patients with RA matched to non-RA patients post PCI. Primary endpoints were time to target lesion revascularisation (TLR) and target vessel revascularisation (TVR) analysed by Cox proportional hazard shared frailty models.
A total of 228 lesions (143 patients) were identified in the RA cohort and matched to 677 control lesions (541 patients). TLR occurred in 33% (n=75) of RA lesions versus 25% (n=166) of control lesions (adjusted HR 1.3; 95% CI 0.97 to 1.8). TVR occurred in 39% (n=89) of RA lesions versus 31% (n=213) of control lesions (adjusted HR 1.15; 95% CI 0.82 to 1.6). There was a significant hazard for TLR (adjusted HR 1.48; 95% CI 1.03 to 2.13) and TVR (adjusted HR 1.55; 95% CI 1.12 to 2.14) when excluding lesions with revascularisation events or follow-up less than 1 year. When stratified by treatment with methotrexate or tumour necrosis factor (TNF) α inhibitors or both at discharge, lesions from patients with RA treated with these agents had similar TVR and TLR as control lesions, whereas lesions from patients with RA not treated with these agents had significantly more TLR and TVR (TLR adjusted HR 1.48; 95% CI 1.08 to 2.03; TVR adjusted HR 1.38; 95% CI 1.04 to 1.84).
RA predisposes to repeat revascularisation, specifically in patients followed after the 1-year landmark. In the absence of RA treatments including methotrexate and/or TNFα inhibitors, RA is associated with a 50% increased relative risk of repeat revascularisation following PCI. These findings emphasise the adverse effects of chronic inflammation on the durability of PCI and provide further support for aggressive anti-inflammatory treatment in patients with RA.
研究类风湿关节炎（RA）患者经皮冠状动脉介入治疗（PCI）后再次血管重建的结局。
我们对PCI术后的RA患者与非RA患者进行了一项单中心回顾性匹配队列研究。主要终点是通过Cox比例风险共享脆弱模型分析的靶病变血管重建（TLR）和靶血管血管重建（TVR）时间。
RA队列中共识别出228个病变（143例患者），并与677个对照病变（541例患者）进行匹配。RA病变中33%（n = 75）发生TLR，而对照病变中为25%（n = 166）（调整后HR 1.3；95%CI 0.97至1.8）。RA病变中39%（n = 89）发生TVR，而对照病变中为31%（n = 213）（调整后HR 1.15；95%CI 0.82至1.6）。排除血管重建事件或随访时间少于1年的病变后，TLR（调整后HR 1.48；95%CI 1.03至2.13）和TVR（调整后HR 1.55；95%CI 1.12至2.14）存在显著风险。按出院时是否使用甲氨蝶呤或肿瘤坏死因子（TNF）α抑制剂或两者进行分层时，接受这些药物治疗的RA患者的病变的TVR和TLR与对照病变相似，而未接受这些药物治疗的RA患者的病变的TLR和TVR明显更多（TLR调整后HR 1.48；95%CI 1.08至2.03；TVR调整后HR 1.38；95%CI 1.04至1.84）。
RA易导致再次血管重建，特别是在1年节点后随访的患者中。在没有包括甲氨蝶呤和/或TNFα抑制剂在内的RA治疗的情况下，RA与PCI后再次血管重建的相对风险增加50%相关。这些发现强调了慢性炎症对PCI耐久性的不利影响，并为RA患者积极的抗炎治疗提供了进一步支持。
