Spartera Marco, Godino Cosmo, Baldissera Elena, Campochiaro Corrado, La Spina Ketty, Aiello Patrizia, Salerno Anna, Cera Michela, Magni Valeria, Jabbour Richard J, Dagna Lorenzo, Tresoldi Moreno, Cappelletti Alberto, Alfieri Ottavio, Colombo Antonio, Sabbadini Maria Grazia, Margonato Alberto
Department of Cardiovascular, San Raffaele Scientific Institute Milan, Italy.
Unit of Internal Medicine and Clinical Immunology, San Raffaele Scientific Institute Milan, Italy.
Am J Cardiovasc Dis. 2017 Feb 15;7(1):9-18. eCollection 2017.
Rheumatoid arthritis (RA) is associated with high morbidity and mortality predominately due to increased cardiovascular risk. Few reports are available regarding the management of coronary artery disease (CAD) in RA patients and the long-term clinical outcomes after coronary revascularization.
All consecutive patients with RA were identified by retrospective review at a rheumatology tertiary center in Milan, Italy between 2001 and 2013. RA patients affected by significant CAD (RA-CAD+) were prospectively followed for major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary revascularization (RA-PCI), coronary artery bypass grafting (RA-CABG) or medical therapy (RA-MT). Among 936 patients with RA, the presence of clinically significant CAD was found in 5.6% (53 patients, RA-CAD+). Of these, 32 patients (60%) underwent PCI (RA-PCI), 10 patients (19%) underwent CABG (RA-CABG) and 11 patients (21%) treated with MT (RA-MT). After a mean follow-up of 9±7 years, the rate of MACCE was 56% in RA-PCI patients, 50% in RA-CABG and 27% in RA-MT patients (P=0.184). The high MACCE rate was mainly driven by repeat coronary revascularization (47%) in the RA-PCI group and high rate of strokes (30%) in RA-CABG patients.
In patients with rheumatoid arthritis and concomitant coronary artery disease (RA-CAD+), we observed at long-term follow-up a high MACCE rate, predominantly in those who underwent coronary revascularization.
类风湿关节炎（RA）与高发病率和死亡率相关，主要是由于心血管风险增加。关于类风湿关节炎患者冠心病（CAD）的管理以及冠状动脉血运重建后的长期临床结局，相关报道较少。
通过对意大利米兰一家风湿病三级中心2001年至2013年的病例进行回顾性分析，确定了所有连续性类风湿关节炎患者。对患有严重冠心病的类风湿关节炎患者（RA-CAD+）在接受经皮冠状动脉血运重建（RA-PCI）、冠状动脉旁路移植术（RA-CABG）或药物治疗（RA-MT）后，进行主要不良心血管和脑血管事件（MACCE）的前瞻性随访。在936例类风湿关节炎患者中，发现5.6%（53例患者，RA-CAD+）存在具有临床意义的冠心病。其中，32例患者（60%）接受了PCI（RA-PCI），10例患者（19%）接受了CABG（RA-CABG），11例患者（21%）接受了MT治疗（RA-MT）。平均随访9±7年后，RA-PCI患者的MACCE发生率为56%，RA-CABG患者为50%，RA-MT患者为27%（P=0.184）。高MACCE发生率主要由RA-PCI组的重复冠状动脉血运重建（47%）和RA-CABG患者的高卒中发生率（30%）所致。
在患有类风湿关节炎并伴有冠心病（RA-CAD+）的患者中，我们在长期随访中观察到高MACCE发生率，主要发生在接受冠状动脉血运重建的患者中。
