Background/Purpose: Inflammation is a risk factor in the development of cardiovascular disease. The proposed etiology centers around accelerated atherosclerosis involving various cytokines in the TNF and IL families. As a result, chronic inflammatory diseases such as RA and gout are thought of as risk factors for the development of cardiovascular disease. There is limited data on comprehensive nationwide analysis of mortality, incidence, and demographic features in patients admitted for acute myocardial infarction (AMI) with underlying RA and gout. Our objectives are to describe the demographics associated with these admissions and report any differences between the inflammatory conditions of RA and gout to the non-inflammatory disease, OA.

Methods: We used the national inpatient sample (NIS) to capture all adult patients ( > 18 years) hospitalized between 2002-2016. Using ICD-9 and -10 codes, we identified hospitalizations with primary diagnosis of AMI and further delineated these patients as having secondary diagnosis of RA, gout, or OA. The NIS is the largest publicly available multi-year hospital care dataset. Incidence and mortality rates were calculated and means/medians were used to describe demographic features. SAS v9.4 was used for all analyses and p < 0.05 was used to determine statistical significance.

Results: We identified 603,359 hospitalizations between 2002-2016 with a primary diagnosis of AMI and secondary diagnoses of RA, gout, or OA. Patients with AMI and secondary diagnosis of RA or gout had higher incidence of admission at a younger age and significantly younger average age of admission for AMI (RA 70.9, 95% CI [70.0-71.1], gout 71.7, 95% CI [71.5-71.9]) compared to those with secondary diagnosis of OA (75.4, 95% CI [75.3-75.6]). Hospitalizations associated with African American race had disproportionally higher incidence of admission for AMI with secondary diagnosis of gout compared to other races. There was a female predominance in those with admission for AMI and secondary diagnosis of RA and OA. The average age of death in those with admission for AMI was significantly lower in those with secondary diagnosis of RA (77.2, 95% CI [76.5-77.9]) or gout (79.0, 95% CI [78.4-79.6]) compared to OA (82.4, 95% CI [82.1-82.8]). Full demographic data is found in Table 1.

Conclusion: Patients with an underlying diagnosis of RA or gout are admitted for AMI at a younger age compared to those with a secondary diagnosis of OA; these same patients also die at a younger age compared to their counterparts with OA. This could reflect the pro-inflammatory disease state in RA and gout predisposing them to accelerated atherosclerosis. A Cleveland Clinic study showed increased prevalence of suboptimal treatment in the African American population likely leading to a higher vascular risk which may contribute to the higher incidence of admission with AMI as we saw in our subgroup. RA is usually diagnosed at an earlier age in women; this longer disease course may also contribute to higher vascular risk manifested by higher incidence of admissions for AMI. Continued awareness and modification of the cardiovascular risks through disease control agents is needed in those with RA and gout to optimize cardiovascular outcomes.

Table 1 for ACR 2019

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/acute-myocardial-infarction-in-rheumatoid-arthritis-gout-and-osteoarthritis-a-retrospective-study-using-the-national-inpatient-sample-from-2002-2016/