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Prognosis After First-Time Myocardial Infarction in Patients With Inflammatory Bowel Disease According to Disease Activity: Nationwide Cohort Study
Study Questions:
What is the effect of active inflammatory bowel disease (IBD) on major adverse cardiovascular outcomes after myocardial infarction (MI)?
Methods:
In nationwide registries, the investigators identified 86,790 patients with first-time MI from the period 2002 to 2011. A total of 1,030 patients had IBD, and the authors categorized their disease activity stages into either flare (120 days), persistent (>120 days) activity, or remission. Short-term mortality was estimated in a logistic regression-model, whereas risk of recurrent MI, all-cause mortality, and a composite of recurrent MI, cardiovascular death, and stroke were estimated by Cox regression models.
Results:
Odds ratio of death during hospitalization or within 30 days of discharge (n = 13,339) corresponded to 3.29 (95% confidence interval [CI], 1.98-5.45) for patients in IBD flares, 1.62 (95% CI, 0.95-2.77) for persistent activity, and 0.97 (95% CI, 0.78-1.19) for remission when compared with the non-IBD group. Among 73,451 patients, including 863 with IBD alive 30 days after discharge, IBD was associated with hazard ratios of 1.21 (95% CI, 0.99-1.49) for recurrent MI, 1.14 (95% CI, 1.01-1.28) for all-cause mortality, and 1.17 (95% CI, 1.03-1.34) for the composite endpoint. When compared with the non-IBD group, IBD flares, in particular, were associated with increased risks of recurrent MI (hazard ratio [HR], 3.09; 95% CI, 1.79-5.32), all-cause mortality (HR, 2.25; 95% CI, 1.61-3.15), and the composite endpoint (HR, 2.04; 95% CI, 1.35-3.06), whereas no increased risk was identified in remission.
Conclusions:
The authors concluded that active IBD worsens prognosis after MI, in particular, in relation with flares.
Perspective:
This study reports that among patients with first-time MI, the risk of recurrent MI, stroke, and the composite endpoints was markedly increased for patients with IBD in periods of flares and persistent activity, while the risk during remission was comparable with that of patients with post-MI without IBD. The results support increased clinical surveillance and treatment aimed at reduction of cardiovascular risk by reducing length and number of flares in patients with IBD, especially for patients with prolonged or repeated disease activity.
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