Clinical Characteristics and Outcomes of Patients with Chronic Systemic Inflammatory Disease in Acute Myocardial Infarction

Hiroaki Yaginuma, Yuichi Saito, Takanori Sato, Daichi Yamashita, Tadahiro Matsumoto, Sakuramaru Suzuki, Shinichi Wakabayashi, Hideki Kitahara, Koichi Sano, Yoshio Kobayashi

Chronic systemic inflammatory diseases (CSIDs) such as rheumatoid arthritis (RA) are reportedly associated with an increased risk of ischemic cardiovascular events including acute myocardial infarction (MI). However, data are limited on clinical characteristics and ischemic and bleeding outcomes after acute MI in patients with CSIDs.

In patients with ischemic heart disease, the identification and targeted strategies against standard modifiable risk factors (SMuRFs) including hypertension, diabetes, dyslipidemia, and smoking contribute to a reduced risk of cardiovascular events, while a sizable proportion of patients with acute myocardial infarction (MI) reportedly have no SMuRFs. Our recent investigation suggested that among patients with acute MI and no SMuRFs, approximately one third of patients had active cancer and autoimmune/inflammatory diseases as a potential underlying risk of MI. Chronic inflammation and related mechanisms including endothelial dysfunction, oxidative stress, macrophage accumulation, and pro-inflammatory cytokines have been considered as a key feature in cardiovascular disease pathogenesis in chronic systemic inflammatory diseases (CSIDs). Previous studies have shown that patients with CSIDs such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and inflammatory bowel disease (IBD) are at an increased risk of cardiovascular events including MI.

This bi-center registry study was done in a retrospective manner. Between January 2012 and March 2020, a total of 1102 patients with acute MI underwent primary PCI at two tertiary referral hospitals in Japan, Chiba University Hospital and Eastern Chiba Medical Center. Acute MI included both ST segment elevation and non-ST segment elevation MI, which was defined based on the fourth universal definition of MI. All PCI procedures were performed per local standard practice with the use of dual antiplatelet therapy, intracoronary imaging, and contemporary drug-eluting stents in most cases. Major exclusion criteria were as follows: active malignancy (n = 61), maintenance hemodialysis (n = 39), MI complicated by aortic dissection (n = 2), and traumatic coronary artery dissection (n = 1). Two of 39 patients with hemodialysis had active malignancy

Of the 1001 patients, 58 (5.8%) had CSIDs, including RA, chronic hepatitis C, SLE, IBDs, and others (Table 2). Baseline patient characteristics are shown in Table 1. The proportion of women was higher in patients with CSIDs than those without (37.9% vs. 22.1%, p = 0.009), while there were no significant differences in the prevalence of SMuRFs (hypertension, diabetes, dyslipidemia, and current smoking) between the two groups (Table 1). In the present study, 69 out of 1001 (6.9%) patients had no SMuRFs.

In the present bi-center registry, more than 5% of patients with acute MI undergoing PCI had CSIDs, most commonly with RA, followed by chronic hepatitis C and SLE. Patients with CSIDs were more likely to be women, although no apparent differences were found in baseline characteristics between the two groups. While the incidence of in-hospital NACE was similar, NACE after discharge more frequently occurred in patients with CSIDs than in those without. Multivariable analysis identified CSIDs as a factor significantly associated with NACE after discharge.

Among patients with acute MI undergoing PCI, CSIDs were found in more than 5% in this bi-center registry in Japan. Although the incidence of in-hospital NACE did not differ significantly between the two groups, CSIDs was associated with a higher risk of NACE after discharge in this study, mainly driven by increased ischemic events. Specific management and therapeutic approaches such as anti-inflammation deserve further investigations in this patient population.

Citation: Yaginuma H, Saito Y, Sato T, Yamashita D, Matsumoto T, Suzuki S, et al. (2023) Clinical characteristics and outcomes of patients with chronic systemic inflammatory disease in acute myocardial infarction. PLoS ONE 18(8): e0289794.

Editor: Jan René Nkeck, Faculty of Medicine and Biomedical Sciences, the University of Yaoundé I, Yaoundé, Cameroon, CAMEROON

Received: March 18, 2023; Accepted: July 21, 2023; Published: August 24, 2023

Copyright: © 2023 Yaginuma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: This work was supported by grants from Chiba Foundation for Health Promotion & Disease Prevention. The funder does not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.