Sharon Van Doornum (firstname.lastname@example.org) Caroline Brand (email@example.com) Vijaya Sundararajan (firstname.lastname@example.org) Andrew E Ajani (email@example.com) Ian P Wicks (firstname.lastname@example.org)
Introduction: The 30-day case fatality rate after acute myocardial infarction (MI) for rheumatoid arthritis (RA) patients is twice that of the general population. This study compared the frequency and timeliness of early reperfusion therapy and treatment with secondary prevention medications after acute MI in RA patients and controls.
Methods: We performed a structured medical chart review of RA patients and matched controls who had been admitted with acute MI to one of three hospitals in Victoria, Australia between 1995 and 2005. The administration and timing of acute reperfusion therapy and in-hospital treatment with secondary prevention medications was compared between the two groups. Acute reperfusion was defined as thrombolysis or percutaneous coronary intervention (PCI) within 12 hours of first symptom of MI.
Results: The medical charts of 90 RA patients and 90 matched controls were reviewed. The RA patients were significantly less likely to receive acute reperfusion compared with the controls (16% versus 37%: odds ratio (OR) 0.27 (95% confidence interval (CI) 0.10-0.64)), and this difference persisted after adjusting for type of MI, clinical setting of MI and prior MI (OR 0.2, 95%; CI 0.05-0.6). The RA patients also received less frequent inhospital treatment with beta blockers (71% versus 83%: OR 0.42 (95% CI 0.18-0.96)) and lipid-lowering agents (40% versus 70%: OR 0.21 (95% CI 0.09-0.46)).