Myocardial infarction and mortality following joint surgery in patients with rheumatoid arthritis

A retrospective cohort study

Joanne Tropea, Caroline A. Brand, Megan Bohensky, Sharon Van Doornum

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)

Abstract

Background: Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction (MI) and post-MI fatality compared with the general population. In a previous study examining post-MI treatment in RA compared with controls we noted that a higher proportion of the RA patients had experienced MI following a surgical procedure. The aim of this study was to compare the risk of MI and mortality at 6 weeks and 12 months following joint surgery in patients with RA compared with the general population. Methods: Individuals who had undergone joint surgery in Victoria, Australia between 1 July 2000 and 30 June 2007 were identified from routinely collected hospital administrative data. Logistic regression analysis was performed to examine odds of 6 week and 12 month MI and mortality in RA versus non-RA patients with adjustment for age, sex, comorbidities, socioeconomic status, patient type and admission type. Subgroup analysis of total hip and knee arthroplasty episodes was undertaken. Results: A total of 308,589 episodes of joint surgery occurred among 240,571 individuals, with 3654 (1.2 %) occurring among patients with RA. At 6 weeks post joint surgery the adjusted odds ratio (OR) for MI was 1.50 (95 % CI 0.96-2.33), all-cause death was 1.85 (95 % CI 1.09-3.13) and cardiovascular death was 1.90 (95 % CI 1.07-3.37). At 12 months post joint surgery the adjusted OR of MI was 1.70 (95 % CI 1.27-2.28), all-cause death was 2.18 (95 % CI 1.66-2.86) and cardiovascular death was 2.30 (95 % CI 1.65-3.22). On analysis of joint surgeries other than hip or knee arthroplasty, people with RA were at greater risk of MI within 6 weeks (adjusted OR 2.32; 95 % CI 1.24-4.34) and 12 months (adjusted OR 2.20; 95 % CI 1.47-3.30) compared to those without RA, but no difference in odds of short term mortality were found. Conclusions: Following an episode of joint surgery RA patients have a significantly increased risk of death at 6 weeks, and MI and death at 12 months, compared to the general population. The reasons for this remain to be elucidated but in the meantime RA patients should be considered at higher risk in the perioperative period.

Original languageEnglish
Article number69
Number of pages8
JournalArthritis Research and Therapy
Volume18
Issue number1
DOIs
Publication statusPublished - 28 Mar 2016

Keywords

  • Cardiovascular risk
  • Joint surgery
  • Mortality
  • Myocardial infarction
  • Perioperative complications
  • Rheumatoid arthritis

Cite this

@article{868a1814af924164b11590b3d6e327c6,
title = "Myocardial infarction and mortality following joint surgery in patients with rheumatoid arthritis: A retrospective cohort study",
abstract = "Background: Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction (MI) and post-MI fatality compared with the general population. In a previous study examining post-MI treatment in RA compared with controls we noted that a higher proportion of the RA patients had experienced MI following a surgical procedure. The aim of this study was to compare the risk of MI and mortality at 6 weeks and 12 months following joint surgery in patients with RA compared with the general population. Methods: Individuals who had undergone joint surgery in Victoria, Australia between 1 July 2000 and 30 June 2007 were identified from routinely collected hospital administrative data. Logistic regression analysis was performed to examine odds of 6 week and 12 month MI and mortality in RA versus non-RA patients with adjustment for age, sex, comorbidities, socioeconomic status, patient type and admission type. Subgroup analysis of total hip and knee arthroplasty episodes was undertaken. Results: A total of 308,589 episodes of joint surgery occurred among 240,571 individuals, with 3654 (1.2 {\%}) occurring among patients with RA. At 6 weeks post joint surgery the adjusted odds ratio (OR) for MI was 1.50 (95 {\%} CI 0.96-2.33), all-cause death was 1.85 (95 {\%} CI 1.09-3.13) and cardiovascular death was 1.90 (95 {\%} CI 1.07-3.37). At 12 months post joint surgery the adjusted OR of MI was 1.70 (95 {\%} CI 1.27-2.28), all-cause death was 2.18 (95 {\%} CI 1.66-2.86) and cardiovascular death was 2.30 (95 {\%} CI 1.65-3.22). On analysis of joint surgeries other than hip or knee arthroplasty, people with RA were at greater risk of MI within 6 weeks (adjusted OR 2.32; 95 {\%} CI 1.24-4.34) and 12 months (adjusted OR 2.20; 95 {\%} CI 1.47-3.30) compared to those without RA, but no difference in odds of short term mortality were found. Conclusions: Following an episode of joint surgery RA patients have a significantly increased risk of death at 6 weeks, and MI and death at 12 months, compared to the general population. The reasons for this remain to be elucidated but in the meantime RA patients should be considered at higher risk in the perioperative period.",
keywords = "Cardiovascular risk, Joint surgery, Mortality, Myocardial infarction, Perioperative complications, Rheumatoid arthritis",
author = "Joanne Tropea and Brand, {Caroline A.} and Megan Bohensky and {Van Doornum}, Sharon",
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Myocardial infarction and mortality following joint surgery in patients with rheumatoid arthritis : A retrospective cohort study. / Tropea, Joanne; Brand, Caroline A.; Bohensky, Megan; Van Doornum, Sharon.

In: Arthritis Research and Therapy, Vol. 18, No. 1, 69, 28.03.2016.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Myocardial infarction and mortality following joint surgery in patients with rheumatoid arthritis

T2 - A retrospective cohort study

AU - Tropea, Joanne

AU - Brand, Caroline A.

AU - Bohensky, Megan

AU - Van Doornum, Sharon

PY - 2016/3/28

Y1 - 2016/3/28

N2 - Background: Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction (MI) and post-MI fatality compared with the general population. In a previous study examining post-MI treatment in RA compared with controls we noted that a higher proportion of the RA patients had experienced MI following a surgical procedure. The aim of this study was to compare the risk of MI and mortality at 6 weeks and 12 months following joint surgery in patients with RA compared with the general population. Methods: Individuals who had undergone joint surgery in Victoria, Australia between 1 July 2000 and 30 June 2007 were identified from routinely collected hospital administrative data. Logistic regression analysis was performed to examine odds of 6 week and 12 month MI and mortality in RA versus non-RA patients with adjustment for age, sex, comorbidities, socioeconomic status, patient type and admission type. Subgroup analysis of total hip and knee arthroplasty episodes was undertaken. Results: A total of 308,589 episodes of joint surgery occurred among 240,571 individuals, with 3654 (1.2 %) occurring among patients with RA. At 6 weeks post joint surgery the adjusted odds ratio (OR) for MI was 1.50 (95 % CI 0.96-2.33), all-cause death was 1.85 (95 % CI 1.09-3.13) and cardiovascular death was 1.90 (95 % CI 1.07-3.37). At 12 months post joint surgery the adjusted OR of MI was 1.70 (95 % CI 1.27-2.28), all-cause death was 2.18 (95 % CI 1.66-2.86) and cardiovascular death was 2.30 (95 % CI 1.65-3.22). On analysis of joint surgeries other than hip or knee arthroplasty, people with RA were at greater risk of MI within 6 weeks (adjusted OR 2.32; 95 % CI 1.24-4.34) and 12 months (adjusted OR 2.20; 95 % CI 1.47-3.30) compared to those without RA, but no difference in odds of short term mortality were found. Conclusions: Following an episode of joint surgery RA patients have a significantly increased risk of death at 6 weeks, and MI and death at 12 months, compared to the general population. The reasons for this remain to be elucidated but in the meantime RA patients should be considered at higher risk in the perioperative period.

AB - Background: Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction (MI) and post-MI fatality compared with the general population. In a previous study examining post-MI treatment in RA compared with controls we noted that a higher proportion of the RA patients had experienced MI following a surgical procedure. The aim of this study was to compare the risk of MI and mortality at 6 weeks and 12 months following joint surgery in patients with RA compared with the general population. Methods: Individuals who had undergone joint surgery in Victoria, Australia between 1 July 2000 and 30 June 2007 were identified from routinely collected hospital administrative data. Logistic regression analysis was performed to examine odds of 6 week and 12 month MI and mortality in RA versus non-RA patients with adjustment for age, sex, comorbidities, socioeconomic status, patient type and admission type. Subgroup analysis of total hip and knee arthroplasty episodes was undertaken. Results: A total of 308,589 episodes of joint surgery occurred among 240,571 individuals, with 3654 (1.2 %) occurring among patients with RA. At 6 weeks post joint surgery the adjusted odds ratio (OR) for MI was 1.50 (95 % CI 0.96-2.33), all-cause death was 1.85 (95 % CI 1.09-3.13) and cardiovascular death was 1.90 (95 % CI 1.07-3.37). At 12 months post joint surgery the adjusted OR of MI was 1.70 (95 % CI 1.27-2.28), all-cause death was 2.18 (95 % CI 1.66-2.86) and cardiovascular death was 2.30 (95 % CI 1.65-3.22). On analysis of joint surgeries other than hip or knee arthroplasty, people with RA were at greater risk of MI within 6 weeks (adjusted OR 2.32; 95 % CI 1.24-4.34) and 12 months (adjusted OR 2.20; 95 % CI 1.47-3.30) compared to those without RA, but no difference in odds of short term mortality were found. Conclusions: Following an episode of joint surgery RA patients have a significantly increased risk of death at 6 weeks, and MI and death at 12 months, compared to the general population. The reasons for this remain to be elucidated but in the meantime RA patients should be considered at higher risk in the perioperative period.

KW - Cardiovascular risk

KW - Joint surgery

KW - Mortality

KW - Myocardial infarction

KW - Perioperative complications

KW - Rheumatoid arthritis

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U2 - 10.1186/s13075-016-0958-5

DO - 10.1186/s13075-016-0958-5

M3 - Article

VL - 18

JO - Arthritis Research and Therapy

JF - Arthritis Research and Therapy

SN - 1478-6354

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