Management and long-term outcomes of patients with chronic inflammatory diseases experiencing ST-segment elevation myocardial infarction: The SCALIM registry

Marouane Boukhris; Nicolas Dupire; Benjamin Dousset; Valérie Pradel; Patrice Virot; Julien Magne; Victor Aboyans

doi:10.1016/j.acvd.2022.09.003

Management and long-term outcomes of patients with chronic inflammatory diseases experiencing ST-segment elevation myocardial infarction: The SCALIM registry

Arch Cardiovasc Dis. 2022 Dec;115(12):647-655. doi: 10.1016/j.acvd.2022.09.003. Epub 2022 Oct 22.

Authors

Marouane Boukhris¹, Nicolas Dupire¹, Benjamin Dousset¹, Valérie Pradel¹, Patrice Virot¹, Julien Magne², Victor Aboyans³

Affiliations

¹ Department of Cardiology, Dupuytren-2 University Hospital, 87042 Limoges, France.
² Department of Cardiology, Dupuytren-2 University Hospital, 87042 Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, 87000 Limoges, France.
³ Department of Cardiology, Dupuytren-2 University Hospital, 87042 Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, 87000 Limoges, France. Electronic address: victor.aboyans@unilim.fr.

PMID: 36372664
DOI: 10.1016/j.acvd.2022.09.003

Abstract

Background: Patients with chronic inflammatory diseases (CIDs) are at increased risk of cardiovascular events. However, the prognostic impact of CID after an acute coronary event has been poorly studied.

Aims: To examine the effect of history of CID on long-term outcome in patients with ST-segment elevation myocardial infarction (STEMI).

Methods: We analysed data from SCALIM, a regional registry that prospectively enrolled patients with STEMI between June 2011 and May 2019. The presence of CID (including inflammatory bowel diseases, rheumatic conditions, inflammatory skin diseases, multiple sclerosis, vasculitis and autoimmune diseases) was identified. The primary outcome was all-cause death. Secondary outcomes were cardiovascular death, myocardial infarction, ischaemic stroke, peripheral vascular events and rehospitalization for cardiovascular conditions.

Results: Data from 1941 patients with STEMI (mean age 64.8±14.1 years, 75.1% men) were analyzed. The prevalence of any CID was 4.6% (n=89). After a mean follow-up of 3.4±2.6 years, the overall death rate was 16.2%, with similar 5-year survival between patients with and without CID (74.2% vs. 81.9%, respectively; P=0.121), with no significant mortality excess (hazard ratio: 1.15, 95% confidence interval: 0.73-1.82; P=0.55). However, among CID patients, 35 (39.3%) were on corticosteroid therapy and showed decreased 5-year survival (52.8% vs. 89.5% without corticosteroids; P=0.001). We found no increased rate of secondary endpoints, except for peripheral vascular events (5-year survival free of peripheral events: 93.3% vs. 98.6% in those without CID; P=0.005).

Conclusions: Approximately 1 in 20 patients with STEMI has CID. We found no effect of CID on long-term survival. However, patients on corticosteroid therapy appeared to have higher rates of death during follow-up. Whether this finding is related to the use of corticosteroids or to the more progressive nature of their condition warrants further investigation.

Keywords: Chronic inflammatory disease; Corticosteroids; Inflammation; STEMI.

MeSH terms

Aged
Brain Ischemia* / etiology
Female
Humans
Male
Middle Aged
Myocardial Infarction* / therapy
Percutaneous Coronary Intervention* / adverse effects
Risk Factors
ST Elevation Myocardial Infarction* / diagnosis
ST Elevation Myocardial Infarction* / etiology
ST Elevation Myocardial Infarction* / therapy
Stroke* / etiology
Time Factors