Background/Purpose: We aimed at investigating and to compare the angiographic pattern of stenoses in patients with rheumatoid arthritis (RA) and general population comparators hospitalized due to acute coronary syndrome (ACS). This was done in a population which we have previously shown to be at increased risk for ACS, at increased risk of death following first event of ACS, and with more severe ACS events than the general population [1]. Our purpose was to investigate whether differences in angiographic findings could explain the more severe ACS phenotype.

Methods: Using nationwide Swedish registries, a cohort of individuals with established RA and general population individuals matched on sex, year of birth, area of residency and educational level were identified between 2006 and 2009. They were followed for a year to identify all cases hospitalized with a first time ACS and admitted to a coronary intensive care unit (CICU). For those with ACS who underwent angiography, the occurrence and extent of coronary stenoses were compared using logistic regression models. Analyses were stratified by diagnosis resulting in coronary angiography (non-ST-elevation myocardial infarction [NSTEMI], ST-elevation myocardial infarction [STEMI]), and adjusted for age and sex. The overall analyses were adjusted for age, sex, and diagnosis.

Results: 1135 RA patients and 3184 general population individuals were hospitalized with ACS during follow-up. Of those, 743 (65%) RA patients and 2203 (69%) general population comparators were admitted to a CICU within ±10 days of the event. 531 (71%) of those RA patients and 1683 (76%) of those general population comparators underwent angiography in conjunction with the ACS event. After adjusting for diagnosis resulting in angiography the adjusted OR for undergoing angiography was 0.84 (95% confidence interval [CI] 0.69, 1.02). Mean age at angiography was 70 years in both groups. 58 % of the RA patients and 53 % of the general population were women. STEMI was a more common indication for investigation in RA (45%) than in the general population (36%). RA patients were more likely to have three-vessel disease than the general population, even after adjusting for diagnosis, age, and sex, OR 1.53 (95% CI 1.04, 2.26). When stratified by indication, we noted an increased risk of having any stenosis, and for three-vessel disease for those with STEMI and for those with NSTEMI. All ORs are found in the table below.

Conclusion: RA patients with ACS seem to have more stenoses and a more unfavourable angiographic pattern than the general population with ACS. This, however, is seen regardless of indication for investigation and therefore does not seem to offer a ready explanation for the more severe presentation of ACS seen in RA. 

Table. Odds ratios (OR) and 95% Confidence Intervals (CI) comparing findings on angiography in RA patients and general population comparators. Normal findings are used as reference group in all models.
	Overall OR (95% CI)	NSTEMI OR (95% CI)	STEMI OR (95% CI)
	Adjusted for age, sex, and diagnosis	Adjusted for age, sex	Adjusted for age, sex
Any stenosis	1.18 (0.88-1.59)	1.12 (0.80-1.56)	1.50 (0.79-2.85)
Any main stem	1.22 (0.76-1.96)	1.10 (0.63-1.93)	1.76 (0.67-4.61)
One vessel, not main stem	1.12 (0.81-1.55)	1.02 (0.70-1.49)	1.40 (0.72-2.72)
Two vessels, not main stem	1.12 (0.78-1.60)	0.99 (0.64-1.52)	1.65 (0.81-3.38)
Three vessels, not main stem	1.53 (1.04-2.26)	1.44 (0.91-2.28)	1.97 (0.92-4.24)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/angiographic-pattern-among-rheumatoid-arthritis-patients-who-are-hospitalized-due-to-acute-coronary-syndrome/