Wang Hong, Li Xinxin, Gong Guoping
Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, P. R. China.
Medicine (Baltimore). 2020 Apr;99(14):e19658. doi: 10.1097/MD.0000000000019658.
Through this analysis, we aimed to systematically compare the cardiovascular outcomes observed in patients with co-existing coronary artery disease (CAD) and rheumatoid arthritis (RA).
Mendeley, Web of Science (WOS), MEDLINE, Cochrane central, EMBASE, Google scholar, and http://www.ClinicalTrials.gov were searched for English-based publications on CAD and RA. Selective cardiovascular outcomes were the endpoints in this analysis. The statistical software RevMan 5.3 was used for data assessment. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent each subgroup analysis.
One thousand four hundred forty six (1446) participants had co-existing CAD and RA whereas 205,575 participants were in the control group (only CAD without RA). This current analysis showed that the risk of asymptomatic or stable angina was similar in CAD patients with versus without RA (RR: 0.98, 95% CI: 0.84 - 1.14; P = .78). However, all-cause mortality (RR: 1.47, 95% CI: 1.34 - 1.61; P = 0.00001), cardiac death (RR: 1.51, 95% CI: 1.05 - 2.17; P = .03) and congestive heart failure (RR: 1.41, 95% CI: 1.27 - 1.56; P = .00001) were significantly higher in CAD patients with RA. However, multi-vessel disease (RR: 2.03, 95% CI: 0.57 - 7.26; P = .28), positive stress test (RR: 1.69, 95% CI: 0.70 - 4.08; P = .24), and ischemic events (RR: 1.18, 95% CI: 0.81 - 1.71; P = .40) were similar in both groups. The risk for myocardial infarction, repeated revascularization, and the probability of patients undergoing percutaneous coronary intervention (PCI) (RR: 1.20, 95% CI: 0.75 - 1.93; P = .45) were also similar in CAD patients with versus without RA. When we considered outcomes only in those patients who underwent revascularization by PCI, all-cause mortality (RR: 1.43, 95% CI: 1.29 - 1.60; P = .00001) was still significantly higher in CAD patients with RA.
This analysis showed a significantly higher mortality risk in CAD patients with RA when compared to the control group. Congestive heart failure also significantly manifested more in CAD patients with co-existing RA. However, the risks all the other cardiovascular outcomes were similar in both groups. Nevertheless, due to the several limitations of this analysis, this hypothesis should be confirmed in forthcoming trials based on larger numbers of CAD patients with co-existing RA.
通过本分析，我们旨在系统比较合并冠状动脉疾病（CAD）和类风湿关节炎（RA）患者的心血管结局。
在Mendeley、科学网（WOS）、医学期刊数据库（MEDLINE）、考克兰中心对照试验注册库、荷兰医学文摘数据库（EMBASE）、谷歌学术以及http://www.ClinicalTrials.gov中检索关于CAD和RA的英文出版物。本分析中的终点为特定的心血管结局。使用统计软件RevMan 5.3进行数据评估。风险比（RR）及其95%置信区间（CI）用于每项亚组分析。
1446名参与者同时患有CAD和RA，而205,575名参与者为对照组（仅患有CAD而无RA）。当前分析表明，患有RA和未患有RA的CAD患者发生无症状或稳定型心绞痛的风险相似（RR：0.98，95%CI：0.84 - 1.14；P = 0.78）。然而，合并RA的CAD患者全因死亡率（RR：1.47，95%CI：1.34 - 1.61；P = 0.00001）、心源性死亡（RR：1.51，95%CI：1.05 - 2.17；P = 0.03）和充血性心力衰竭（RR：1.41，95%CI：1.27 - 1.56；P = 0.00001）显著更高。然而，两组的多支血管病变（RR：2.03，95%CI：0.57 - 7.26；P = 0.28）、运动试验阳性（RR：1.69，95%CI：0.70 - 4.08；P = 0.24）和缺血事件（RR：1.18，95%CI：0.81 - 1.71；P = 0.40）相似。患有RA和未患有RA的CAD患者发生心肌梗死、再次血运重建的风险以及接受经皮冠状动脉介入治疗（PCI）的概率（RR：1.20，95%CI：0.75 - 1.93；P = 0.45）也相似。当我们仅考虑那些接受PCI血运重建的患者的结局时，合并RA的CAD患者全因死亡率（RR：1.43，95%CI：1.29 - 1.60；P = 0.00001）仍然显著更高。
本分析表明，与对照组相比，合并RA的CAD患者死亡风险显著更高。合并RA的CAD患者充血性心力衰竭也显著更常见。然而，两组所有其他心血管结局的风险相似。尽管如此，由于本分析存在若干局限性，这一假设应在即将开展的基于更多合并RA的CAD患者的试验中得到证实。
